Madácsy L, Velösy B, Lonovics J, Csernay L
First Department of Medicine, Albert Szent-Györgyi Medical University, Szeged, Hungary.
Eur J Nucl Med. 1995 Mar;22(3):227-32. doi: 10.1007/BF01081517.
Attempts have long been made to use the prostigmine-morphine provocation test for the selection of postcholecystectomy patients suffering from sphincter of Oddi (SO) dyskinesia. Since the whole procedure is based upon the evaluation of subjective complaints, this test has frequently been criticized. To improve the diagnostic value of this method, we have visualized SO spasms during prostigmine-morphine provocation by means of quantitative hepatobiliary scintigraphy (QHBS). Twenty-two cholecystectomized patients with typical postprandial biliary pain were included in this study. In the first series of studies, QHBS with technetium-99m 2,6-diethylphenylcarbamoylmethyl-diacetic acid was performed in each patient 2 days before prostigmine-morphine provocation. The time to peak activity (Tmax) and the half-time of excretion (T1/2) over the liver parenchyma (LP), hepatic hilum (HH) and common bile duct (CBD), and the duodenum appearance time (DAT), were determined and served as control values. In the second series of experiments, sphincter spasms were evoked by prostigmine-morphine administration and visualized by means of QHBS. The same parameters were evaluated and serum levels of aspartate aminotransferase (AST) were determined simultaneously at regular intervals. In 12 patients who responded to prostigmine-morphine provocation with typical biliary pain and a significant AST elevation (Nardi positive group) the hepatobiliary scintigram demonstrated a marked biliary obstruction. Tmax and T1/2 over the LP, HH and CBD were significantly increased, while DAT was significantly longer relative to the corresponding data obtained without provocation. Four of the remaining ten patients indicated atypical abdominal pain during prostigmine-morphine provocation, but the AST level remained unchanged in all ten (Nardi negative group).(ABSTRACT TRUNCATED AT 250 WORDS)
长期以来，人们一直试图使用新斯的明 - 吗啡激发试验来筛选患有Oddi括约肌（SO）运动障碍的胆囊切除术后患者。由于整个过程基于主观症状的评估，该试验经常受到批评。为了提高这种方法的诊断价值，我们通过定量肝胆闪烁显像（QHBS）在新斯的明 - 吗啡激发试验期间观察SO痉挛情况。本研究纳入了22例有典型餐后胆绞痛的胆囊切除患者。在第一系列研究中，在新斯的明 - 吗啡激发试验前两天，对每位患者进行用锝 - 99m 2,6 - 二乙基苯基氨基甲酰甲基 - 二乙酸的QHBS检查。测定肝实质（LP）、肝门（HH）和胆总管（CBD）的峰值时间（Tmax）和排泄半衰期（T1/2）以及十二指肠出现时间（DAT），并将其作为对照值。在第二系列实验中，通过给予新斯的明 - 吗啡诱发括约肌痉挛，并通过QHBS进行观察。评估相同参数，并定期同时测定血清天冬氨酸转氨酶（AST）水平。在12例对新斯的明 - 吗啡激发试验有典型胆绞痛且AST显著升高的患者（Nardi阳性组）中，肝胆闪烁显像显示明显的胆道梗阻。相对于未激发时获得的相应数据，LP、HH和CBD的Tmax和T1/2显著增加，而DAT显著延长。其余10例患者中有4例在新斯的明 - 吗啡激发试验期间表现为非典型腹痛，但所有10例患者的AST水平均未改变（Nardi阴性组）。（摘要截断于250字）
