急性胆嚢炎における超音波像の経時的変化について

DOI: 10.3179/jjmu. JJMU.A.50
◇ ORIGINAL ARTICLE ◇
急性胆嚢炎における超音波像の経時的変化について
川端聡1
森亘平1
田上展子1
植野珠奈1
尾羽根範員1
山片重人2
津村京子1
西村重彦2
仙崎菜々恵1
山田晃3
抄録
目的：急性胆嚢炎における各種超音波検査（US）所見が発現する時間帯を明らかにすることで診断精度の向上が
望めるかを検討した．対象と方法：2010 年 1 月から 2015 年 2 月までの急性胆嚢炎 128 例のうち，発症日時が特定
でき，US 施行までの期間に積極的治療が行われていなかった 69 症例（男性 41 例，女性 28 例，平均年齢 54. 0 歳）
について，時間経過に伴う各種 US 所見（胆嚢腫大，胆泥，壁肥厚，壁内低エコー帯，胆嚢周囲液体貯留，膿瘍形
成）の出現頻度を調べた．結果と考察：時間経過とともに腫大，胆泥および壁肥厚，低エコー帯，周囲液体貯留，
膿瘍形成の順に出現頻度が増加した．発症後 10 時間以内に検査された 70. 0％（7 / 10）には腫大しかみられず，
また腫大しかみられなかった 10 例全例が発症後 15 時間以内に US が施行されており，腫大のみでも 15 時間以内
であれば急性胆嚢炎を否定できないと考えられた．また発症 24 時間以降に US が施行された 91. 7％（33 / 36）に
は少なくとも腫大＋胆泥＋壁肥厚がみられ，発症後 24 時間以降で腫大，胆泥，壁肥厚の何れもみられない場合は
急性胆嚢炎の可能性が低いと考えられた．結論：急性胆嚢炎における各種 US 所見の出現順序と，それらが発現す
る時間帯を把握することで診断精度の向上が望めると考えられた．
Temporal changes of ultrasound images in acute cholecystitis
Satoshi KAWABATA, RMS1, Nobuko TAGAMI, RMS1, Norikazu OBANE, RMS1, Kyoko TSUMURA, RMS1,
Nanae SENZAKI, RMS1, Kohei MORI1, Juna UENO1, Shigehito YAMAGATA, FJSUM2,
Shigehiko NISHIMURA, FJSUM2, Akira YAMADA, FJSUM3
Abstract
Purpose : To investigate the possibility of improving the diagnostic accuracy by identifying the time course of various
Ultrasonography（US）¿ndings of acute cholecystitis. Subjects and Methods : The subjects were 69 patients（41 male
and 28 female patients, mean age : 54. 0 years old）who developed acute cholecystitis between January 2010 and February
2015, in whom the onset date and time could be identified and active treatment was not performed prior to US
examination. We investigated the time-course incidences of various US ¿ndings（gallbladder enlargement, biliary sludge,
wall thickening, intramural hypoechoic layer, Àuid retention around the gallbladder, and abscess formation）. Results and
Discussion : The incidences of swelling, biliary sludge, gallbladder wall thickening, hypoechoic layer, Àuid retention
around the gallbladder, and abscess formation increased over time in this order. Swelling alone was noted in 70. 0％
（7 / 10）of patients who were examined within 10 hours after onset, and all such patients were examined by US within 15
hours after onset, suggesting that acute cholecystitis cannot be ruled out within 15 hours, even though only swelling is
observed. In 91. 7％（33 / 36）of patients who were examined by US 24 or more hours after development, at least
swelling ＋ biliary sludge ＋ wall thickening were observed, suggesting that when swelling, biliary sludge, and wall
thickening are not observed 24 or more hours after development, acute cholecystitis is unlikely. Conclusion : Diagnostic
accuracy may be improved by investigating the order of the development of various US ¿ndings of acute cholecystitis
and the time course of their development.
Keywords
acute cholecystitis, ultrasonography, ultrasonography ¿ndings, elapsed time, diagnostic imaging
1
住友病院診療技術部超音波技術科，2同外科，3 同消化器内科
Department of Ultrasonography, 2Surgery, 3Digestive Tract Internal Medicine, Sumitomo Hospital, 5-3-20 Nakanoshima, Kita Osaka 5300005, Japan
Received on June 10, 2015; Revision accepted on August 24, 2015 J-STAGE. Advanced published. date: November 24, 2015
1
Jpn J Med Ultrasonics

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