한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제14권2호
  • /
  • Pages.110-115
  • /
  • 2010
  • /
  • 2508-5778(pISSN)
  • /
  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
권호 표지

쓸개운동이상증의 수술치료와 약물치료의 성적 비교

The Comparison of Medical and Surgical Treatment for Gallbladder Dyskinesia

  • 발행 : 2010.06.30
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The purpose of this study was to compare outcomes for surgical treatment with those for medical treatment of GB dyskinesia. Methods: Retrospective analysis of medical records and telephone interviews of 67 patients diagnosed with GB dyskinesia was done at Pohang St. Mary' Hospital between January 2004 and December 2009. Group 1 (n=18) patients received laparoscopic cholecystectomy. Group 2 (n=49) patients received medical treatment. GB dyskinesia was the diagnosis if the patient had typical biliary colic symptoms without GB stones or other GI disease, and if the ejection fraction was less than 35% on Tc-99m-DISIDA scans. Results: The average age of patients diagnosed with GB dyskinesia was 45.8 years old. The sex ratio was 15:52 (male:female). The average symptom duration was 25.4 days. All had RUQ and, or epigastric pain. There were no significant between group differences in age, sex ratio, symptom duration, symptoms, follow up period, and ejection fraction. In group 1, patient symptoms improved after treatment in 16 cases (88.9%); in group 2, patient symptoms improved in 19 cases (38.8%). Surgical treatment was significantly more effective than medical treatment. The reasons for choosing medical treatment were predominantly the preference of the doctors. Conclusion: Surgical treatment is a more effective treatment for GB dyskinesia than medical treatment. Therefore, laparoscopic cholecystectomy should be considered as the 1st line treatment of choice for GB dyskinesia.

키워드

참고문헌

  1. Yost F, Margenthaler J, Presti M, Burton F, Murayama K. Cholecystectomy is an effective treatment for biliary dyskinesia. Am J Surg 1999;178:462-465. https://doi.org/10.1016/S0002-9610(99)00228-7
  2. Sorenson MK, Fancher S, Lang NP, Eidt JF, Broadwater JR. Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia. Am J Surg 1993;166:672-674. https://doi.org/10.1016/S0002-9610(05)80677-4
  3. George J, Baillie J. Biliary and gallbladder dyskinesia. Curr Tret Options Gastroenterol 2007;10:322-327. https://doi.org/10.1007/s11938-007-0075-2
  4. Szepes A, Bertalan V, Varkonyi T, Pavics L, Lonovics J, Madacsy L. Diagnosis of gallbladder dyskinesia by quantitative hepatobiliary scintigraphy. Clin Nucl Med 2005;30:302-307. https://doi.org/10.1097/01.rlu.0000159522.19509.30
  5. Goncalves RM, Harris JA, Rivera DE. Biliary dyskinesia: natural history and surgical results. Am Surg 1998;64:493-497.
  6. Gall CA, Chambers KJ. Cholecystectomy for gallbladdr dyskinesia: symptom resolution and satisfaction in a rural surgical practice. ANZ J Surg 2002;72:731-734. https://doi.org/10.1046/j.1445-2197.2002.02531.x
  7. Ozden N, DiBaise JK. Gallbladder ejection fraction and symptom outcome in patients with acalculous bliliary-like pain. Dig Dis Sci 2003;48:890-897. https://doi.org/10.1023/A:1023039310574
  8. Hwang IS, Rhu KH, Choi BJ, et al. The evaluation of gabllbladder function by Tc-99m-DISIDA scintigraphy in diabetic patients. Korean J Med 1998;54:514-522.
  9. Rastogi A, Slivka A, Moser AJ, Wald A. Controversies concerning pathophysiology and management of acalculous biliary-type abdominal pain. Dig Dis Sci 2005;50:1391-1401. https://doi.org/10.1007/s10620-005-2852-x
  10. Barbara L, Sama C, Morselli Labate AM, et al. A population study on the prevalence of gallstone disease: the sirmione study. Hepatology 1987;7:913-917. https://doi.org/10.1002/hep.1840070520
  11. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). The epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. Hepatology 1988;8:904-906. https://doi.org/10.1002/hep.1840080433
  12. Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Prevalence of gallstone disease in an Italian adult female population. Am J Epidemiol 1984;119: 796-805.
  13. Tabet J, Anvari M. Laparoscopic cholecystectomy for gallbladder dyskinesia: clinical outcome and patient satisfaction. Surg Laparosc Endosc Percutan Tech 1999;9:382-386.
  14. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology 2006;130:1377-1390. https://doi.org/10.1053/j.gastro.2006.03.008
  15. Krishnamurthy GT, Brown PH. Comparison of fatty meal and intravenous cholecystokinin infusion for gallbladder ejection fraction. J Nucl Med 2002;43:1603-1610.
  16. Kuribayashi S, Monden T, Nakajima H, Ishizuka T, Kusano M, Mori M. Usefulness of cholescintigrahy with lipid meal loading for diagnosis and determination of cholecystectomy in a patient with gallbladder dysfunction. Intern Med 2004;43: 393-396. https://doi.org/10.2169/internalmedicine.43.393
  17. DiBaise JK, Oleynikov D. Does gallbladder ejection fraction predict outcome after cholecystectomy for suspected chronic acalculous gallbladder dysfunction? A systemic review. Am J Gastroenterol 2003;98:2605-2611. https://doi.org/10.1111/j.1572-0241.2003.08772.x
  18. Paajanen H, Miilunpohja S, Joukainen S, Heikkinen J. Role of quantitative cholescintigraphy for planning laparoscopic cholecystectomy in patients with gallbladder dyskinesia and chronic abdominal pain. Surg Laparosc Endosc Percutan Tech 2009;19:16-19. https://doi.org/10.1097/SLE.0b013e31818eb2e5
  19. Patel NA, Lamb JJ, Hogle NJ, Fowler DL. Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia. Am J Surg 2004;187:209-212. https://doi.org/10.1016/j.amjsurg.2003.11.027
  20. Yap L, Wycherley AG, Morphett AD, Toouli J. Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy. Gastroenterology 1991;101: 786-793. https://doi.org/10.1016/0016-5085(91)90540-2
  21. Ruffolo TA, Sherman S, Lehman GA, Hawes RH. Gallbladder ejection fraction and its relationship to sphincter of Oddi dysfunction. Dig Dis Sci 1994;39:289-292. https://doi.org/10.1007/BF02090199
  22. Ponsky TA, DeSagun R, Brody F. Surgical therapy for biliary dyskinesia: a meta-analysis and review of the literature. J Laparoendosc Adv Surg Tech A 2005;15:439-442. https://doi.org/10.1089/lap.2005.15.439
  23. Kim JJ, Jeong JH, Chung ID. Clinical analysis of 500 consecutive laparoscopic cholecystectomies. Korean J Hepatobiliary Pancreat Surg 1999;3:115-125.
  24. Lim MS, Joo SH, Lee S, Park CH, Kim JS. Laparoscopic cholecystectomy in elderly patients. Korean J Hepatobiliary Pancreat Surg 2004;8:185-189.
  25. Johanning JM, Gruenberg JC. The changing face of cholecystectomy. Am Surg 1998;64:643-647.
  26. Kim JY, Lee MK, Kang YJ, Kim CN, Cho BS, Park JS. Clinical analysis of acalculous cholecystitis. Korean J Hepatobiliary Pancreat Surg 2005;9:216-220.