Burnstein M J, Vassal K P, Strasberg S M
Ann Surg. 1982 Dec;196(6):627-32. doi: 10.1097/00000658-198212001-00001.
Combined biliary drainage-cholecystokinin cholecystography (BD-CC) was evaluated in 81 patients with pain indistinguishable from biliary colic, but normal conventional diagnostic tests. The test was performed using a new technique of intubation and aspiration, with a steerable catheter and sump duodenal tube. Both positive and negative groups were followed. One third of patients had positive tests, and almost all had pathologic gallbladders, and a symptomatic outcome equal to that obtained by cholecystectomy for cholelithiasis diagnosed by conventional means. Some patients with severe pain had cholecystectomy despite a negative report. Pathologic findings were significantly fewer, and symptomatic outcome less satisfactory but sufficiently good to suggest that painful functional gallbladder abnormalities, not amenable to diagnosis by BD-CC exist. Hypercontraction was found to be a reliable index of gallbladder pathology. A false bilirubin precipitate was identified in some patients; this precipitate may be recognized by microscopy and pH testing. This finding should reduce false-positives in BD-CC.
对81例疼痛症状与胆绞痛难以区分但常规诊断检查正常的患者进行了联合胆管引流-胆囊收缩素胆囊造影（BD-CC）评估。该检查采用一种新的插管和抽吸技术，使用可操纵导管和十二指肠引流管。对阳性和阴性两组患者均进行了随访。三分之一的患者检查结果为阳性，几乎所有患者都有病变胆囊，其症状转归与通过传统方法诊断为胆结石而行胆囊切除术的患者相当。一些疼痛严重的患者尽管报告为阴性仍接受了胆囊切除术。病理检查结果明显较少，症状转归不太令人满意，但仍足够好，表明存在疼痛性功能性胆囊异常，无法通过BD-CC诊断。发现胆囊过度收缩是胆囊病变的可靠指标。在一些患者中发现了假胆红素沉淀；这种沉淀可通过显微镜检查和pH测试识别。这一发现应可减少BD-CC中的假阳性结果。
