Acute Cholecystitis: How Urgent as Revealed by CT Signs?

急性膽囊炎：由電腦斷層攝影徵象反映有多緊急？

吳淑萍(Suk-Ping Ng)；鄭旭萌(She-Meng Cheng)；施焄鏻(Shin-Lin Shih)

急性膽囊炎 ； 併發症 ； 電腦斷層攝影 ； 緊急情況 ； Acute cholecystitis ； Complication ； Computed tomography ； CT ； Emergency

中華放射線醫學雜誌

29卷1期（2004 / 02 / 01）

15 - 20

英文

急性膽囊炎可以有很多電腦斷層攝影可以看到的徵象，但對於臨床的急性程度的相關性卻沒有被討論。因為電腦斷層攝影中看到的徵象往往是病理病變的表現，所以推論應該與臨床表現有一定的相關性。65個急性膽囊炎的病人的電腦斷層攝影徵象由二位放射科醫師追溯研究，根據所看到的電腦斷攝影徵象作分類：第一組為無急性膽囊炎徵象，第二組為有急性膽囊炎但沒有併發症徵象，第三組為有囊內併發症徵象，及第四組為合併囊外併發症徵象。我們發現這個分組和臨床的急性程度有相關，表現在緊急開刀的比例。對於第一組病人，沒有人進行緊急開刀。緊急開刀的比例與徵象所表示的嚴重程度同樣逐步升高（第一組0%，第二組20%，第三組41%，第四組75%）我們總結電腦斷層攝影上所見的徵象並不是只能單純作為診斷有沒有急性膽囊炎，它還可以作為臨床上嚴重程度的參考。

Various signs of acute cholecystitis can be identified on CT examination, but these signs have not been correlated with clinical severity. Since CT signs of acute cholecystitis reflect underlying pathological changes, it is reasonable to postulate that they may related to clinical severity. CT scans in 65 patients with acute cholecystitis were retrospectively reviewed by two radiologists. Patients were categorized in groups according to the CT signs: group 1 had no radiographic evidence of cholecystitis, group 2 had uncomplicated cholecystitis, group 3 had intraluminal complications, and group 4 had extra-luminal complications. We found good correlation between the category based on CT sings of acute cholecystitis and the clinical severity. The frequency of emergency operations increased with increasing severity of CT sings (0% for group 1 disease, 20% for group 2 disease, 41% for group 3 disease, and 75% for group 4 disease). We concluded that CT signs identified in acute cholecystitis are useful not only for diagnosis but also for assessing clinical severity.