Giá trị của cắt lớp vi tính trong chẩn đoán viêm túi mật cấp không có biến chứng và có biến chứng

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Tác giả: Khắc Vũ Bùi, Hoàng Anh Châu, Quang Huy Huỳnh, Minh Nhật Nguyễn, Cảnh Minh Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.188

Bộ sưu tập: Metadata

ID: 286516

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Đặt vấn đề: Viêm túi mật cấp là một trong những bệnh lý cấp cứu ngoại khoa thường gặp, trong đó viêm túi mật cấp có biến chứng làm gia tăng đáng kể tỷ lệ tử vong, cần được can thiệp ngoại khoa cấp cứu. Cắt lớp vi tính là phương tiện hình ảnh học giúp chẩn đoán xác định viêm túi mật cấp, phát hiện các biến chứng tại chỗ, từ đó nâng cao chất lượng điều trị và giảm thiểu tỷ lệ tử vong của bệnh. Mục tiêu: Mô tả đặc điểm hình ảnh và giá trị của cắt lớp vi tính trong chẩn đoán viêm túi mật cấp không có biến chứng và có biến chứng. Đối tượng và phương pháp nghiên cứu: Nghiên cứu cắt ngang bao gồm 58 trường hợp viêm túi mật cấp không có biến chứng và 66 trường hợp viêm túi mật cấp có biến chứng dựa trên kết quả phẫu thuật và giải phẫu bệnh, được chụp cắt lớp vi tính trong vòng 24 giờ trước khi phẫu thuật cắt túi mật từ tháng 01/2022 đến hết tháng 12/2023, tại Bệnh viện Nhân dân Gia Định. Mô tả, phân tích và so sánh sự khác biệt các đặc điểm lâm sàng, hình ảnh trên cắt lớp vi tính giữa 2 nhóm viêm túi mật cấp. Kết quả: Tuổi và chỉ số CRP ở nhóm viêm túi mật cấp có biến chứng lớn hơn có ý nghĩa thống kê so với nhóm viêm túi mật cấp không có biến chứng (với p = 0,005 và p <
0,001). Trong các đặc điểm hình ảnh trên cắt lớp vi tính, có sự khác biệt có ý nghĩa thống kê giữa 2 nhóm viêm túi mật cấp về đường kính ngang túi mật (p = 0,033), độ dày thành túi mật (p = 0,032), đậm độ dịch trong lòng túi mật (p <
0,001), tăng quang kém thành túi mật (p <
0,001), màng trong lòng túi mật (p = 0,007), mất liên tục thành túi mật (p = 0,002), áp xe quanh túi mật (p = 0,002), thâm nhiễm mỡ (p <
0,001) và tụ dịch xung quanh túi mật (p <
0,001). Độ nhạy, độ đặc hiệu cắt lớp vi tính trong chẩn đoán viêm túi mật cấp có biến chứng lần lượt là 78,8% và 81% khi có ≥ 4 dấu hiệu hình ảnh dương tính. Kết luận: Cắt lớp vi tính là phương tiện hình ảnh tốt trong chẩn đoán viêm túi mật cấp không có biến chứng và có biến chứng với độ nhạy và độ đặc hiệu cao. Abstract Background: Acute cholecystitis is one of the most common surgical emergencies and acute cholecystitis with complications significantly increases the mortality rate, requiring emergency surgical intervention. Computed tomography is an imaging method that helps to diagnose acute cholecystitis, detect local complications, thereby improving the quality of treatment and reducing the mortality rate of the disease. Objective: To describe the imaging findings of uncomplicated and complicated acute cholecystitis and the value of computed tomography in diagnosing. Methods: A cross - sectional study. We performed a review of 66 cases with histopathology and surgical report proved of complicated acute cholecystitis and 58 cases of uncomplicated acute cholecystitis, with had computed tomography within 24 hours before cholecystectomy from January 2022 to the end of December 2023, at Nhan dan Gia Dinh Hospital. Describe, analyze and compare the differences in clinical characteristics and computed tomography images between the 2 groups of acute cholecystitis. Results: Age and CRP index of complicated acute cholecystitis group were statistically significantly higher than uncomplicated acute cholecystitis group (p = 0.005 and p <
0.001). In the imaging characteristics on computed tomography, there was a statistically significant difference between the 2 groups of acute cholecystitis in gallbladder distention (p = 0.033), gallbladder wall thickness (p = 0.032), HU value of intraluminal bile (p <
0.001), decreased mural enhancement (p <
0.001), intraluminal membranes (p = 0.007), mural defect (p = 0.002), pericholecystic abscess (p = 0.002), pericholecystic stranding (p <
0.001) and pericholecystic fluid (p <
0.001). The sensitivity and specificity of computed tomography in diagnosing complicated acute cholecystitis were 78.8% and 81%, when there were ≥ 4 positive imaging signs. Conclusions: Computed tomography is a good imaging modality in diagnosing uncomplicated and complicated acute cholecystitis with high sensitivity and specificity. DOI: 10.59715/pntjmp.3.4.23

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