Falco E, Magliani L, Biassoni P, Barbera F, Costa R, Schenone F, Conzi G F
II Divisione di Chirurgia Generale, Ospedale Civile S. Andrea, La Spezia.
Minerva Chir. 1993 Apr 30;48(8):387-92.
Hepatobiliary scintigraphy with analogs of iminodiacetic acid (IDA) has become one of the primary tools in the diagnosis of biliary tract diseases, especially in the evaluation of surgical results and detection of complications that may arise from biliary operative procedures. We have performed cholescintigraphy in 19 patients. Of them, 9 underwent choledochojejunostomy with Roux-en-Y reconstruction for recurrent choledocholithiasis, 1 underwent right hepatic resection for metastasis extirpation, 8 were post cholecystectomy patients effected with upper abdominal pain located either in the epigastric region or right upper quadrant referable to post cholecystectomy syndrome and the last exhibited chronic pancreatitis ans suspicious sphincter of Oddi stenosis. The scintigraphy data were compared with the information yielded by sonography, intravenous cholangiogram (IVC) and, when possible, by endoscopic retrograde cholangiopancreatography (ERCP). Scans were considered pathologic when one or more of the following criteria were present: a) delayed biliary to bowel transit (greater than 1 hr), b) abnormal time-activity dynamic, c) no intestinal activity (obstruction), d) apparent ductal dilatation. In the group of biliary-enteric anastomosed patients, cholescintigraphic findings have shown 3 normal cases, 3 cases of biliary-intestinal obstruction confirmed by surgery, and 3 with abnormal activity retention in the jejunum loop due, in 2 patients, to hypokinesia since the quick emptying following the administration of 10 mg i.v. of metoclopramide, while in the other one, the surgery reexploration exhibited the presence of adhesions producing intestinal stricture. in the last patient of this group, the cholescintigraphy was performed to detect possible biliary leaks. In the post cholecystectomy patients, the cholescintigraphy exhibited in 3 cases dilated common duct with functional patency since the normal biliary-bowel transit time (less than 1 hr); this was confirmed by sonogram and IVC.(ABSTRACT TRUNCATED AT 250 WORDS)
使用亚氨基二乙酸（IDA）类似物进行肝胆闪烁扫描已成为诊断胆道疾病的主要工具之一，尤其在评估手术结果以及检测胆道手术可能引发的并发症方面。我们对19例患者进行了胆系闪烁扫描。其中，9例因复发性胆总管结石接受了带有Roux-en-Y重建的胆总管空肠吻合术，1例因转移灶切除接受了右肝切除术，8例为胆囊切除术后患者，因上腹部疼痛（位于上腹部区域或右上腹，归因于胆囊切除术后综合征）前来就诊，最后1例表现为慢性胰腺炎且怀疑存在Oddi括约肌狭窄。将闪烁扫描数据与超声检查、静脉胆管造影（IVC）以及（如有可能）内镜逆行胰胆管造影（ERCP）所提供的信息进行了比较。当出现以下一项或多项标准时，扫描结果被视为异常：a）胆汁向肠道的转运延迟（超过1小时），b）时间-活性动态异常，c）无肠道活性（梗阻），d）明显的导管扩张。在胆肠吻合患者组中，胆系闪烁扫描结果显示3例正常，3例经手术证实为胆肠梗阻，3例空肠袢存在异常的活性滞留，其中2例是由于静脉注射10毫克甲氧氯普胺后排空过快导致动力不足，而在另一例中，再次手术探查发现存在导致肠道狭窄的粘连。在该组的最后一名患者中，进行胆系闪烁扫描以检测可能的胆漏。在胆囊切除术后患者中，胆系闪烁扫描显示3例胆总管扩张且功能通畅，因为胆汁向肠道的转运时间正常（少于1小时）；这一点通过超声检查和IVC得到了证实。（摘要截断于250字）
