Cicala M, Scopinaro F, Corazziari E, Vignoni A, Viscardi A, Habib F I, Torsoli A
Cattedra di Gastroenterologia I, Universitá La Sapienza, Rome, Italy.
Gastroenterology. 1991 Apr;100(4):1106-13. doi: 10.1016/0016-5085(91)90289-w.
Quantitative cholescintigraphy has been proposed as a noninvasive method to assess function of the sphincter of Oddi in cholecystectomized subjects. The present study evaluated several quantitative cholescintigraphic variables to assess their time-related variability as well as their capability to detect delay of choledochoduodenal bile flow. Cholescintigraphy with 2,6-diethylphenylcarbahoylmethyl diacetic acid 99mTc was performed in 24 cholecystectomized patients with recurrent biliary-like pain, laboratory evidence of bile stasis, normal hepatocellular function tests, and no evidence of choledocholithiasis. The study was also performed in 26 asymptomatic cholecystectomized subjects and repeated at 2-week intervals during identical experimental conditions in 10 of them. Of the following quantitative cholescintigraphic variables investigated, (a) hepatic T peak, (b) 50% hepatic retention (T peak, 1/2), (c) percent hepatic retention at 30 minutes, (d) percent hepatic retention at 40 minutes, (e) vein-hepatic hilum transit time, (f) vein-duodenum transit time, and (g) hepatic hilum-duodenum transit time, only the hepatic hilum-duodenum transit time showed a statistically significant correlation between the duplicate studies. Only vein-duodenum transit time and hepatic hilum-duodenum transit time discriminated the symptomatic from the asymptomatic patients; of the two variables, however, hepatic hilum-duodenum transit time showed less intrasubject variability and no overlap between the two groups of patients. Hepatic hilum-duodenum transit time showed a positive linear correlation with the maximum diameter of the choledochus. It is concluded that in cholecystectomized patients, the hepatic hilum-duodenum transit time appears to detect a delay of bile flow into the intestine better than any other cholescintigraphic variable. However, in patients with a dilated common bile duct, this variable cannot discriminate bile flow delay due to increased choledochal capacity and/or obstruction of the sphincter of Oddi.
定量胆闪烁造影已被提议作为一种非侵入性方法，用于评估胆囊切除术后患者的Oddi括约肌功能。本研究评估了几个定量胆闪烁造影变量，以评估它们随时间的变异性以及检测胆总管十二指肠胆汁流动延迟的能力。对24例有复发性胆绞痛样疼痛、胆汁淤积实验室证据、肝细胞功能测试正常且无胆总管结石证据的胆囊切除患者进行了用99mTc标记的2,6-二乙基苯基碳酰甲基二乙酸的胆闪烁造影。该研究也在26例无症状胆囊切除患者中进行，其中10例在相同实验条件下每隔2周重复进行一次。在所研究的以下定量胆闪烁造影变量中，(a)肝脏T峰值，(b)50%肝脏滞留率（T峰值，1/2），(c)30分钟时肝脏滞留百分比，(d)40分钟时肝脏滞留百分比，(e)静脉-肝门转运时间，(f)静脉-十二指肠转运时间，以及(g)肝门-十二指肠转运时间，只有肝门-十二指肠转运时间在重复研究之间显示出统计学上的显著相关性。只有静脉-十二指肠转运时间和肝门-十二指肠转运时间能区分有症状和无症状患者；然而，在这两个变量中，肝门-十二指肠转运时间在个体内的变异性较小，且两组患者之间没有重叠。肝门-十二指肠转运时间与胆总管最大直径呈正线性相关。结论是，在胆囊切除患者中，肝门-十二指肠转运时间似乎比任何其他胆闪烁造影变量能更好地检测胆汁流入肠道的延迟。然而，在胆总管扩张的患者中，该变量无法区分由于胆总管容量增加和/或Oddi括约肌梗阻导致的胆汁流动延迟。
