Computed Tomography Scanning for Diagnosing Gallbladder Rupture: Experience with 64 Cases

電腦斷層攝影應用於膽囊破裂之診斷：64例經驗

周俊雄(Chun-Hsiung Chou) ； 陳泰源(Tai-Youeng Chen) ； 潘慧本(Huny-Ben Pan) ； 黃哲勳(Jer-Shyung Huang) ； 楊宗龍(Tsung-Lung Yang) ； 楊建芳(Chien-Fang Yang)

《中華放射線醫學雜誌》 25卷1期 (2000/02) Pp. 13-16

摘要

膽囊破裂是急性膽囊炎中常見的併發症，病患的腹痛點大都位於右上腹，但是有時因膽囊破裂路徑的不同而有所差異。此研究的目的在於利用電腦斷層攝影做為膽囊破裂術前評估的工具，並且分析其可能破裂的路徑。我們收集從1993到1998六年來以電腦斷層攝影於術前診斷為膽囊破裂的64個病例，其中55例是男性，9例為女性。年齡分佈於44至88歲，平均年齡為53歲。術前診斷膽囊破裂的標準為：1膽囊壁不連續或2膽囊壁旁局部組織液的聚集合併有膽囊壁明顯的對比顯影及膽囊旁明顯的組織反應。在這些研究系列中，手術證實破裂者共57例，術前診斷率為89%。在這些膽囊破裂的病例中，37例破裂流至膽囊窩；30例穿透至肝臟；12例至右側肝下區；10例至左側肝下區；7例至右側橫膈下區以及1例至後腹腔，沒有1例遠離右上腹區域。因此電腦斷層攝影是一項術前診斷膽囊破裂及評估破裂走向的利器。

關鍵字

膽囊 ； 電腦斷層攝影 ； 穿孔 ； 膽囊炎

並列摘要

Rupture of the gallbladder is one of the most common complications of acute cholecystitis. The abdominal pain is always located in the right upper quadrant but presentations sometimes vary according to the rupture route and biloma formation. The aim of our study was to evaluate the true positive rate of gallbladder rupture using computed tomography (CT) scanning and to determine the possible leakage routes following gallbladder rupture. We collected 64 cases of gallbladder rupture diagnosed by CT scanning during the period form 1993 through 1998. Fifty-five patients were men and nine were women. Their ages ranged from 44 to 88 years old, with a mean age of 53 years. The diagnostic criterion for gallbladder rupture on the CT scans was: (1) gallbladder wall disruption or (2) local fluid collection surrounding the gallbladder wall combined with contrast enhancement of the gallbladder wall and a desmoplastic reaction in the area surrounding the gallbladder. There were 57 surgically proven gallbladder ruptures. The positive predictive rate was 89%. There was leakage to the gallbladder fossa in 37 cases, to the right subhepatic area in 12, to the left subhepatic area in 10, to the right subphrenic area in seven, and to the retroperitoneum in one and penetration to the liver bed in 30. There was no leakage outside the right upper quadrant. CT scanning is a good modality for detecting gallbladder rupture and for demonstrating the routes of extravasated fluid from a gallbladder rupture.

並列關鍵字

Gallbladder ； CT ； perforation ； Cholecystitis