超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 45(6): 574-582 (2020)
doi:10.11272/jss.312

研究Research Paper

超音波検査で分類した胆囊の形状と胆囊結石保有の関連The Relationship between Gallbladder Morphology Classified by Ultrasound and the Presence of Gallbladder Stones

1上田病院超音波検査室Unit of Ultrasound, Ueda Hospital

2上田病院内科Department of Internal Medicine, Ueda Hospital

3上田病院外科Department of Surgery, Ueda Hospital

4大阪大学大学院医学系研究科老年総合内科学Geriatric and General Medicine, Osaka University Graduate School of Medicine

受付日:2019年12月20日Received: December 20, 2019
受理日:2020年8月24日Accepted: August 24, 2020
発行日:2020年12月1日Published: December 1, 2020
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目的:胆囊結石(胆石)の形成因子や形成機序に関する研究は古くから行われているものの,胆囊形状と胆石保有の関連に着目した研究は少ない.そこで,本研究では胆石の有無と胆石の種類を胆囊形状別に比較検討することに加え,胆石保有に最も影響する因子を知ることを目的とした.

対象と方法:2019年4月から2019年10月に,当院でスクリーニング目的に腹部超音波検査を施行した144例(男性78例,女性66例,平均年齢75±13歳[34~95歳])を対象とした.胆囊形状を洋梨型,くびれ型,屈曲型に分類し,胆石の有無を胆囊形状別に比較した.そして,保有する胆石を大胆石と小胆石に分類し,胆囊形状別に比較した.また,胆石の有無と年齢・性別・Body mass index・糖尿病・脂質異常症・胆囊形状の関連を検討した.

結果と考察:胆囊形状は洋梨型97例,くびれ型26例,屈曲型21例に分類された.胆石の保有は洋梨型11例,くびれ型5例,屈曲型12例であり,屈曲型で有意に高値を示した(p<0.001).大胆石や小胆石の保有と胆囊形状に有意差はみられなかった.また,胆石保有には胆囊形状(屈曲型)が有意に影響した(オッズ比:10.35, 95%信頼区間:3.42–31.32, p<0.001).屈曲型に胆石の保有が有意であったことについては,胆囊内での胆汁うっ滞が関与していると考えられた.

結論:胆石保有に最も影響する因子は屈曲型を呈する胆囊であり,超音波検査で分類した胆囊の形状は胆石保有に関連していることが示唆された.

Purpose: Although the factors and mechanisms behind the formation of gallbladder stones (gallstones) have been studied for many years, few investigations have focused on the relationship between gallbladder morphology and the presence of gallstones. Therefore, this study was performed to obtain this information by comparing the presence or absence of gallstones and type of gallstone with the different morphological types of gallbladders, to determine the factors most commonly linked to the presence of gallstones.

Subjects and Methods: In total, we evaluated 144 subjects (78 men and 66 women; mean age, 75±13 years; range, 34–95 years) who underwent an abdominal ultrasound at our hospital to screen for gallstones, between April and October 2019. Gallbladder morphology was classified into pyriform, hourglass-shaped, and flexed types, and the presence or absence of gallstones was compared among these types. Gallstones were classified as large and small, and their prevalence was compared according to gallbladder morphology. The relationship between the presence or absence of gallstones and age, body mass index, diabetes, dyslipidemia, and gallbladder morphology was determined.

Results and Discussion: Regarding gallbladder morphology, 97 subjects had the pyriform-type, 26 had the hourglass-type, and 21 had the flexed-type. Gallstones were found in 11, 5, and 12 subjects with pyriform, hourglass, and flexed types, respectively. Furthermore, subjects with a flexed-type gallbladder had a significantly higher prevalence(p<0.001),which was thought to be related to bile congestion. No significant differences were observed in the prevalence of large or small gallstones among the gallbladder morphological types. Flexed-type gallbladder morphology was significantly associated with the presence of gallstones (odds ratio, 10.35; 95% confidence interval 3.42–31.32; p<0.001).

Conclusion: Flexed-type gallbladder was most significantly associated with the presence of gallstones, suggesting that gallbladder morphology determined by ultrasound is an indicator of the presence of gallstones.

Key words: Gallbladder morphology; factors for gallstone formation; bile congestion; qualitative diagnosis; Tsuchiya’s classification

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