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Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered?

Annals of Surgical Treatment and Research 2020년 99권 4호 p.221 ~ 229
강경아, 권헌주, 함수연, 박희진, 신준호, 이성렬, 김미성,
소속 상세정보
강경아 ( Kang Kyung-A ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Radiology
권헌주 ( Kwon Heon-Ju ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Radiology
함수연 ( Ham Soo-Youn ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Radiology
박희진 ( Park Hee-Jin ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Radiology
신준호 ( Shin Jun-Ho ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery
이성렬 ( Lee Sung-Ryol ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Surgery
김미성 ( Kim Mi-Sung ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Radiology

Abstract


Purpose: We evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy.

Methods: We performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP.

Results: There were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed.

Conclusion: MRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.

키워드

Cholecystectomy; Laparoscopic; Magnetic resonance cholangiopancreatography

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