Pace R F, Chamberlain M J, Passi R B
Can J Surg. 1983 Mar;26(2):191-3.
The diagnosis of papillary stenosis, occasionally seen after cholecystectomy, is confirmed by endoscopic retrograde cholangiopancreatography (ERCP), which demonstrates delayed emptying of contrast material into the duodenum for more than 45 minutes. The authors assessed 2,6-dimethyl phenyl carbamoyl methyl iminodiacetic acid labelled with technetium-99m (99mTc HIDA) as a less invasive procedure in these circumstances by comparing it with the findings from ERCP. Twenty-six patients who had pain after cholecystectomy were studied by continuous 1-hour scintigraphy after injection of 99mTc HIDA. Biliary flow was estimated by measuring uptake and clearance of the entire liver and common bile duct. Volunteers who had no pain after cholecystectomy served as controls. Of the 26 study patients, all 99mTc HIDA scan findings were within the control range in 11. Of these, 10 had normal biliary drainage confirmed by ERCP. The one patient with delayed drainage did not improve after endoscopic sphincterotomy. Two patients demonstrated pooling of 99mTc HIDA in cystic dilatations of the biliary tree, while the other 13 patients had obstruction of the distal common bile duct and impaired flow demonstrated on the 99mTc HIDA scan. All 13 of these patients had papillary stenosis proven by ERCP. The authors conclude that 99mTc HIDA scanning is a valuable, minimally invasive method of diagnosing papillary stenosis.
乳头狭窄偶尔在胆囊切除术后出现，经内镜逆行胰胆管造影（ERCP）确诊，该检查显示对比剂排入十二指肠延迟超过45分钟。作者通过将99m锝标记的2,6 - 二甲基苯基氨基甲酰甲基亚氨基二乙酸（99mTc HIDA）与ERCP的检查结果相比较，评估其在这些情况下作为一种侵入性较小的检查方法的效果。对26例胆囊切除术后仍有疼痛的患者在注射99mTc HIDA后进行了连续1小时的闪烁扫描研究。通过测量整个肝脏和胆总管的摄取及清除情况来估计胆汁流量。以胆囊切除术后无疼痛的志愿者作为对照。在26例研究患者中，11例患者的所有99mTc HIDA扫描结果均在对照范围内。其中，10例经ERCP证实胆汁引流正常。1例引流延迟的患者在内镜括约肌切开术后并无改善。2例患者的99mTc HIDA在胆管树的囊性扩张处有聚集，而其他13例患者在99mTc HIDA扫描中显示胆总管远端梗阻且胆汁流动受损。所有这13例患者经ERCP证实有乳头狭窄。作者得出结论，99mTc HIDA扫描是诊断乳头狭窄的一种有价值的、微创方法。
