대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제85권3호
  • /
  • Pages.581-595
  • /
  • 2024
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

담낭 절제술 후 총담관 직경의 장기 변화에 대한 CT 평가

CT Evaluation of Long-Term Changes in Common Bile Duct Diameter after Cholecystectomy

  • 안성희 (연세대학교 의과대학 영상의학교실) ;
  • 안찬식 (차의과대학교 일산차병원 영상의학과) ;
  • 김승섭 (연세대학교 의과대학 영상의학교실) ;
  • 박수미 (국민건강보험공단 일산병원 영상의학과)
  • Sung Hee Ahn (Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Chansik An (Department of Radiology, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Seung-seob Kim (Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Sumi Park (Department of Radiology, National Health Insurance Service Ilsan Hospital)
  • 투고 : 2023.03.30
  • 심사 : 2023.07.12
  • 발행 : 2024.05.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적 본 연구는 담낭절제술 후 보상적 총담관 확장의 빈도와 정도를 조사하고, 담낭절제술과 common bile duct (이하 CBD) 확장 사이의 시간을 평가하고, 폐쇄성 CBD 확장을 암시하는 잠재적으로 유용한 CT 소견을 식별하는 것을 목표로 한다. 대상과 방법 2009년에서 2011년 사이에 단일 센터에서 담낭절제술 전후에 여러 차례 CT 스캔을 받은 담도 폐쇄가 없는 121명의 환자를 대상으로 한 후향적 연구를 진행하였다. 또한 담낭절제술 후 CBD 결석 또는 팽대부 종양으로 인해 초기에 연구에서 제외되었던 11명의 환자의 임상 및 CT 소견을 조사하여 폐쇄성 및 비폐쇄성 CBD 확장의 특징을 확인하였다. 결과 121명의 환자의 평균(표준편차) 단축 최대 CBD 직경은 담낭절제술 전 축면에서 5.6(± 1.9) mm였지만 담낭절제술 후 7.9 (± 2.6) mm로 증가했다(p < 0.001). 담낭절제술 전 축성 CBD 직경이 8 mm 미만인 106명의 환자 중 39명(36.8%)이 담낭절제술 후 ≥ 8 mm의 CBD 확장을 보였다. 장기(> 2년) 연속 추적 CT 스캔을 받은 17명의 환자 중 6명(35.3%)은 결국 모두 담낭 절제술 후 2년 이내에 축성 CBD 직경이 유의미하게(> 1.5배) 증가한 것으로 나타났다. 폐색 또는 관련 증상이 없는 121명의 환자 중 단 1명(0.1%)만이 담낭 절제술 후 intrahepatic duct (이하 IHD) 확장 > 3 mm를 보였던 반면, CBD 폐쇄가 있는 11명의 환자 모두 복통과 비정상 검사실 지수가 있었고 81.8% (9/11)가 IHD 및 CBD의 상당한 확장을 보였다. 결론 보상적 비폐쇄성 CBD 확장은 일반적으로 폐쇄성 확장과 비슷한 정도로 담낭절제술 후에 발생한다. 그러나 담낭절제술 후 담관 폐색과 관련 증상이 있거나, 의미 있는 IHD 확장 또는 2-3년 후 추가적인 CBD 확장이 발생하는 경우 CBD 폐쇄를 의심해야 한다.

Purpose The present study aimed to investigate the frequency and extent of compensatory common bile duct (CBD) dilatation after cholecystectomy, assess the time between cholecystectomy and CBD dilatation, and identify potentially useful CT findings suggestive of obstructive CBD dilatation. Materials and Methods This retrospective study included 121 patients without biliary obstruction who underwent multiple CT scans before and after cholecystectomy at a single center between 2009 and 2011. The maximum short-axis diameters of the CBD and intrahepatic duct (IHD) were measured on each CT scan. In addition, the clinical and CT findings of 11 patients who were initially excluded from the study because of CBD stones or periampullary tumors were examined to identify distinguishing features between obstructive and non-obstructive CBD dilatation after cholecystectomy. Results The mean (standard deviation) short-axis maximum CBD diameter of 121 patients was 5.6 (± 1.9) mm in the axial plane before cholecystectomy but increased to 7.9 (± 2.6) mm after cholecystectomy (p < 0.001). Of the 106 patients with a pre-cholecystectomy axial CBD diameter of < 8 mm, 39 (36.8%) showed CBD dilatation of ≥ 8 mm after cholecystectomy. Six of the 17 patients with long-term (> 2 years) serial follow-up CT scans (35.3%) eventually showed a significant (> 1.5-fold) increase in the axial CBD diameter, all within two years after cholecystectomy. Of the 121 patients without obstruction or related symptoms, only one patient (0.1%) showed IHD dilatation > 3 mm after cholecystectomy. In contrast, all 11 patients with CBD obstruction had abdominal pain and abnormal laboratory indices, and 81.8% (9/11) had significant dilatation of the IHD and CBD. Conclusion Compensatory non-obstructive CBD dilatation commonly occurs after cholecystectomy to a similar extent as obstructive dilatation. However, the presence of relevant symptoms, significant IHD dilatation, or further CBD dilatation 2-3 years after cholecystectomy should raise suspicion of CBD obstruction.

키워드

참고문헌

  1. Caraiani C, Yi D, Petresc B, Dietrich C. Indications for abdominal imaging: when and what to choose? J Ultrason 2020;20:e43-e54
  2. Holm AN, Gerke H. What should be done with a dilated bile duct? Curr Gastroenterol Rep 2010;12:150-156
  3. Freitas ML, Bell RL, Duffy AJ. Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol 2006;12:3162-3167
  4. Kuwatani M, Sakamoto N. Asymptomatic choledocholithiasis that causes a dilemma between treatment and observation. JMA J 2021;4:176-177
  5. Kim JE, Lee JK, Lee KT, Park DI, Hyun JG, Paik SW, et al. The clinical significance of common bile-duct dilatation in patients without biliary symptoms or causative lesions on ultrasonography. Endoscopy 2001;33:495-500
  6. Kim CW, Chang JH, Lim YS, Kim TH, Lee IS, Han SW. Common bile duct stones on multidetector computed tomography: attenuation patterns and detectability. World J Gastroenterol 2013;19:1788-1796
  7. Heinzow HS, Kammerer S, Rammes C, Wessling J, Domagk D, Meister T. Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World J Gastroenterol 2014;20:10495-10503
  8. Bachar GN, Cohen M, Belenky A, Atar E, Gideon S. Effect of aging on the adult extrahepatic bile duct: a sonographic study. J Ultrasound Med 2003;22:879-882
  9. Benjaminov F, Leichtman G, Naftali T, Half EE, Konikoff FM. Effects of age and cholecystectomy on common bile duct diameter as measured by endoscopic ultrasonography. Surg Endosc 2013;27:303-307
  10. Perret RS, Sloop GD, Borne JA. Common bile duct measurements in an elderly population. J Ultrasound Med 2000;19:727-730
  11. Park JS, Lee DH, Jeong S, Cho SG. Determination of diameter and angulation of the normal common bile duct using multidetector computed tomography. Gut Liver 2009;3:306-310
  12. Senturk S, Miroglu TC, Bilici A, Gumus H, Tekin RC, Ekici F, et al. Diameters of the common bile duct in adults and postcholecystectomy patients: a study with 64-slice CT. Eur J Radiol 2012;81:39-42
  13. Pavlovi'cT, Trtica S, Troskot Peri'c R. Bile duct diameter changes after laparoscopic cholecystectomy: a magnetic resonance cholangiopancreatography prospective study. Croat Med J 2020;61:239-245
  14. Kratzer W, Wahl S, Vonend C, Schmidt SA, Ozturk S, Hanle MM, et al. Caliber of the common bile duct: effect of cholecystectomy and other factors in a ultrasonographic study of 8534 patients. Z Gastroenterol 2015;53:1161-1166
  15. Park SM, Kim WS, Bae IH, Kim JH, Ryu DH, Jang LC, et al. Common bile duct dilatation after cholecystectomy: a one-year prospective study. J Korean Surg Soc 2012;83:97-101
  16. Chawla S, Trick WE, Gilkey S, Attar BM. Does cholecystectomy status influence the common bile duct diameter? A matched-pair analysis. Dig Dis Sci 2010;55:1155-1160
  17. Valkovic P, Miletic D, Zelic M, Brkljacic B. Dynamic changes in the common bile duct after laparoscopic cholecystectomy: a prospective longitudinal sonographic study. Ultraschall Med 2011;32:479-484
  18. Bhalerao SBS, Batra P, Utaal MS, Sasan C. Evaluation of effect of cholecystectomy on common bile duct diameter using ultrasonography and liver function test: a prospective study. Int Surg J 2018;5:1323-1329
  19. Puri SK, Gupta P, Panigrahi P, Kumar N, Gupta S, Chaudhary A. Ultrasonographic evaluation of common duct diameter in pre and post cholecystectomy patients. Trop Gastroenterol 2001;22:23-24
  20. Hunt DR, Scott AJ. Changes in bile duct diameter after cholecystectomy: a 5-year prospective study. Gastroenterology 1989;97:1485-1488
  21. Rosenthal SJ, Cox GG, Wetzel LH, Batnitzky S. Pitfalls and differential diagnosis in biliary sonography. Radiographics 1990;10:285-311
  22. Worku MG, Enyew EF, Desita ZT, Moges AM. Sonographic measurement of normal common bile duct diameter and associated factors at the University of Gondar comprehensive specialized hospital and selected private imaging center in Gondar town, North West Ethiopia. PLoS One 2020;15:e0227135
  23. Piyawong W, Lekhavat V. Normal measurement of diameters of the common bile ducts in different aged groups. J Med Assoc Thai 2016;99 Suppl 4:S153-S158
  24. Maqsood H, Goussous N, Parthasarathy M, Horne C, Kaur G, Setiawan L, et al. Does computed tomography (CT) overestimate common-bile-duct diameter in the evaluation of gallstone pancreatitis? J Pancreas 2016;17:196-200