Thiyagarajan Manuneethimaran, Kamaraj Eniyan, Navrathan Nitesh, Thyagarajan Mohanapriya, Singh Krishna Balaji
General Surgery Department, Sri Ramachandra Medical University, Chennai, India.
Minim Invasive Surg. 2019 Feb 14;2019:5705039. doi: 10.1155/2019/5705039. eCollection 2019.
Pathogenesis of gallstone includes bile stasis due to defect in the gallbladder muscle contraction. Our aim of the study is to find out the role of 99mTc-HIDA scan in assessment of gallbladder dyskinesia in cholelithiasis patients before laparoscopic cholecystectomy and compare the gallbladder dyskinesia with various parameters like symptoms of patients, diabetic status of patients, gallstones size and number, and cholecystitis features in histopathology report after surgery.
This is a prospective observational study conducted at our hospital for three years. Totally 40 patients with gallstone were subjected to 99mTc-HIDA scan, to assess the ejection fraction of gallbladder. For all these patients detailed clinical history, presence of comorbid illness like diabetics, and symptomatology were elicited. For all patients, ultrasonogram of abdomen was done to assess number and size of stones. All parameters were tabulated and correlated.
While comparing 99mTc-HIDA scan findings with symptoms of patients, 21.2% were asymptomatic and 78.8% symptomatic patients who had ejection fraction less than 80%. All patients in EF >80% group were symptomatic only. It is not statistically significant. On comparing 99mTc-HIDA scan findings with diabetic status of the patients, 42.4% of diabetic and 57.6 % of nondiabetic patients had ejection fraction less than 80%. It is not statistically significant (0.681). While comparing 99mTc-HIDA scan findings with size of the gallstone in ultrasound, 63.6% patients with size less than 1cm and 36.4% with size more than 1cm had ejection fraction < 80%. It is statistically significant (0.048). On comparing 99mTc-HIDA scan findings with number of stones in ultrasound, 18.2% single gallstone patients and 81.8% multiple gallstone patients had EF less than 80% which is statistically significant (0.001). While comparing the 99mTc-HIDA scan findings with histopathology report after laparoscopic cholecystectomy, 21.2% non-cholecystitis patients and 78.8% cholecystitis patients had EF less than 80%, which is statistically (0.017) significant.
99mTc-HIDA scan can be an accurate method to diagnose the gallbladder dyskinesia. Gallbladder dyskinesia in 99mTc-HIDA scan can be used to predict large size stones and multiple stones before surgery. The sensitivity can be improved by 99mTc-HIDA scan in diagnosing cholecystitis patients.
胆结石的发病机制包括胆囊肌肉收缩缺陷导致的胆汁淤积。本研究的目的是探讨99mTc-HIDA扫描在腹腔镜胆囊切除术前行胆囊运动功能障碍评估中的作用，并将胆囊运动功能障碍与患者症状、糖尿病状态、胆结石大小和数量以及术后组织病理学报告中的胆囊炎特征等各种参数进行比较。
这是一项在我院进行了三年的前瞻性观察研究。共有40例胆结石患者接受了99mTc-HIDA扫描，以评估胆囊的射血分数。收集了所有这些患者的详细临床病史、是否存在糖尿病等合并疾病以及症状。对所有患者进行腹部超声检查，以评估结石的数量和大小。所有参数都进行了列表和相关性分析。
将99mTc-HIDA扫描结果与患者症状进行比较时，21.2%的患者无症状，78.8%有症状的患者射血分数低于80%。射血分数>80%组的所有患者均有症状。这无统计学意义。将99mTc-HIDA扫描结果与患者的糖尿病状态进行比较时，42.4%的糖尿病患者和57.6%的非糖尿病患者射血分数低于80%。这无统计学意义（0.681）。将99mTc-HIDA扫描结果与超声检查中胆结石的大小进行比较时，63.6%结石大小小于1cm的患者和36.4%结石大小大于1cm的患者射血分数<80%。这具有统计学意义（0.048）。将99mTc-HIDA扫描结果与超声检查中结石的数量进行比较时，18.2%的单发胆结石患者和81.8%的多发胆结石患者射血分数低于80%，这具有统计学意义（0.001）。将99mTc-HIDA扫描结果与腹腔镜胆囊切除术后的组织病理学报告进行比较时，21.2%的非胆囊炎患者和78.8%的胆囊炎患者射血分数低于80%，这具有统计学意义（0.017）。
99mTc-HIDA扫描可以成为诊断胆囊运动功能障碍的准确方法。99mTc-HIDA扫描中的胆囊运动功能障碍可用于术前预测大尺寸结石和多发结石。99mTc-HIDA扫描在诊断胆囊炎患者时可提高敏感性。
