cystic duct syndrome
Introduction
Introduction to cystic duct syndrome Cystic duct syndrome (cysticductsyndrome) refers to the incompleteness of the cystic duct, non-calculus, mechanical obstruction, a group of clinical syndromes characterized by biliary colic caused by poor bile discharge and elevated gallbladder pressure. Intrinsic, also known as cystic duct partial obstruction syndrome, gallbladder dyskinesia syndrome, primary chronic cysticulitis. basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: chronic cholecystitis
Cause
Causes of cystic duct syndrome
(1) Causes of the disease
The etiology has congenital and acquired factors, and the latter factors are more common. It has been confirmed that many structural abnormalities can lead to incomplete obstruction of the cystic duct, such as inflammatory adhesion of the cystic duct, distortion of the cystic duct, and adhesion of the gallbladder to surrounding organs. The cystic duct-funnel connection is acute, limited stenosis, cystic duct fibrosis, etc., due to partial obstruction of the cystic duct, obstruction of bile outflow, bile retention in the gallbladder causes elevation of gallbladder pressure, resulting in a series of clinical symptoms .
(two) pathogenesis
In patients with cystic duct syndrome, gallbladder enlargement is often seen in open surgery, and there is a certain degree of dilatation. After the finger presses the gallbladder, the bile can not be empty, and the gallbladder itself can be abnormal. The pathological examination of the cystic duct often sees mild to moderate. Inflammatory changes, thickened wall or more typical hyperplastic changes.
Prevention
Prevention of cystic duct syndrome
Causes the occurrence of cystic duct syndrome (such as: inflammatory adhesion of the cystic duct, distortion of the cystic duct too long, cystic duct fibrosis, etc.), so the primary disease of the treatment of post-natal factors is the key to prevention, prevention of gallbladder The disease occurs, maintain a balanced diet, pay attention to a low-fat diet.
Complication
Complications of cystic duct syndrome Complications chronic cholecystitis
Chronic inflammation of the cystic duct, fibrosis, distortion of the cystic duct, and narrowing of the cystic duct.
Symptom
Symptoms of cystic duct syndrome common symptoms biliary colic weight loss abdominal discomfort persistent pain right upper quadrant pain gallbladder wall fibrosis gallbladder volume shrinkage gallbladder systolic dysfunction
The prominent symptom of the syndrome is pain. It can be located in the gallbladder or upper abdomen. It can occasionally radiate to the back. It can induce obvious pain after a fat meal. Therefore, some patients have sharply reduced food intake, weight loss, and sometimes severe pain with paroxysmal attacks. It is indistinguishable from biliary colic. Some patients can wake up during sleep. The pain lasts for several hours. Nitroglycerin or anticholinergic drugs may relieve pain, but the effect is not completely certain, and the effective time is short. Sometimes there is gallbladder. The area is tender, but rarely reaches the enlarged gallbladder.
Examine
Examination of cystic duct syndrome
Laboratory inspection
Blood routine white blood cell count, classification and liver function tests in patients with cystic duct syndrome are basically normal.
Film degree exam
The examination methods include various bile drainage methods, continuous gallbladder angiography, cholecystokinin cholecystography, etc. If it can be confirmed that the gallbladder is a powerful and ineffective contraction to overcome the resistance, it is helpful for diagnosis, and the reliability of cholecystokinin gallbladder angiography better.
1. Gallbladder angiography: After the oral gallbladder contrast agent, the gallbladder is well filled, but the emptying is delayed. After 36h, the gallbladder is still developed. At the same time, the cystic duct is narrow, twisted, slender and other changes, the common bile duct is light or not developed, and the cholecystokinin gallbladder Pre-contrast preparation is the same as oral cholecystography. Slowly (within 3 minutes) intravenous injection of 75U CCK. Since normal people can have gallbladder neck contraction when they are injected quickly, slow injection is for safety reasons and to avoid gallbladder neck contraction. The volume of gallbladder in normal people is 50%-80% lower than that before injection, while that in patients with cystic duct syndrome is only 5%~45%, not more than 45%, and most patients have more round gallbladder. In addition, large In most patients, cystic duct stenosis or contrast agent interruption can be seen during angiography. The indispensable part of diagnosing cystic duct syndrome is that when the CCK is injected, the gallbladder area will feel pain. The normal person can have mild diffuseness after slow injection of CCK. Pain or spastic pain, which is caused by irritation of bowel movements without localized pain in the gallbladder area.
2. Bile drainage examination: duodenal bile drainage, bile delay, after stimulation with cholecystokinin, bile flowed out after 6 to 20 minutes, and the amount is small, lasting for a long time; bile drainage under CCK stimulation, such as It was found that the delayed onset of dark bile (B bile) was the most diagnostic value. After injection of CCK, there was no B bile in 20 minutes after the injection of CCK, while normal people saw B bile on average about 6 min. In addition, patients with this syndrome B bile volume is also reduced, the efflux time is prolonged, and the intermittent effusion is intermittent. The bile drainage in the case of CCK injection is helpful for diagnosing the syndrome, but it is not necessary to perform bile drainage for cholecystokinin gallbladder angiography. an examination.
3. Radionuclide biliary scanning: 99mTc-HIDA radionuclide biliary scanning, gallbladder emptying delayed more than 4h, the diagnosis of cystic duct syndrome can be based on the following points:
(1) There is post-meal biliary colic or right upper quadrant discomfort, but no chills and high fever, jaundice and white blood cells rise.
(2) Oral gallbladder contrast agent or radionuclide biliary scanning showed good gallbladder filling, but there was delay in emptying and cystic duct changes.
(3) B-mode ultrasound, CT, MRI, X-ray cholecystography and other examinations did not find gallstones and space-occupying lesions.
When the above methods are still unable to make a diagnosis, the following methods can be used to assist in the diagnosis: 1 biliary radiometry plus cholangiography, 2 injections of contrast agent into the gallbladder, and tracking of contrast agent to the duodenum under radiation Through this method, it is easy to determine the presence and location of the blockage.
Diagnosis
Diagnosis and differentiation of cystic duct syndrome
According to typical pain, there is no stone in the gallbladder angiography and the gallbladder is well filled. If the bile can not be fully empty after the fat meal, the cystic duct syndrome should be suspected, but the other auxiliary examinations mentioned above are needed for the diagnosis.
Differential diagnosis
According to the typical pain, there is no stone in the gallbladder angiography and the gallbladder is well filled. If the bile can not be fully empty after the fat meal, the cystic duct syndrome should be suspected, but the diagnosis should be combined with the above examination. The diseases to be identified include:
1. Cholelithiasis: Patients with small gallstones in the cystic duct can behave like cystic duct syndrome, including clinical symptoms, CCK-stimulated bile drainage and gallbladder angiography. Small stones in the cystic duct can be removed during gallbladder removal. Or postoperative anatomy was found.
2. Chronic cholecystitis and gallbladder hyperplasia: patients with non-calculous chronic cholecystitis often see gallbladder not filling or filling obstruction, gallbladder hyperplasia, especially in patients with adenomyosis, CCK can occur after injection of CCK, gallbladder patients with such diseases The delay or acceleration of emptying is not the same, and the corresponding gallbladder morphological changes are easily found in the angiography.
Cholecystectomy syndrome and non-calculous chronic cholecystitis and gallbladder hyperplasia may overlap in pathophysiology, pathological anatomy and morphology. Common cystic duct syndrome has mild to moderate chronic inflammation of the gallbladder, thickening of the wall; gallbladder hyperplasia Symptoms and chronic cholecystitis patients also have symptoms, mainly due to obstruction of gallbladder emptying and narrowing of the gallbladder neck or cystic duct. It can be seen that after the stenosis or partial obstruction of the cystic duct, the gallbladder wall muscle can be compensated. Hyperplasia, hypertrophy.
3. Low gallbladder tension: In patients with low gallbladder tension, gallbladder angiography can be well filled due to the presence of cholecystokinin antagonists, but gallbladder contraction is poor or unable to contract. At the same time or after the injection of CCK, there is usually no pain. High-tension type in sphincter motor dysfunction causes less cystic duct syndrome than mechanical obstruction, but pain can also occur in CCK gallbladder angiography, gallbladder filling is good, biliary tract contraction is poor, and cystic duct is often obvious Development, the diameter is often above 8mm, the contrast agent has little or no access to the duodenum, and the cystic duct of the cystic duct syndrome is not developed or blurred, in addition, serotonin and anticholinergic drugs in patients with sphincter dyskinesia The reaction is better.
4. Pancreatic duodenal disease: organic diseases of the pancreatic duodenum, including duodenum, ampullary and pancreatic tumors, pancreatitis, have radiological and laboratory examination features and are not easy to with the gallbladder The tube syndrome is confused and can be identified by ERCP and gallbladder angiography if necessary.
