Gani J S
Division of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.
Aust N Z J Surg. 1998 Jul;68(7):514-9. doi: 10.1111/j.1445-2197.1998.tb04814.x.
Patients referred to general surgeons for the treatment of gall-bladder stones were studied to evaluate the role of sincalide cholescintigraphy as a gall-bladder stress test in an effort to identify a group of patients whose pain was non-biliary in origin and who would not be improved by cholecystectomy.
Ten asymptomatic controls and 57 patients with gallstones and abdominal symptoms were studied. All patients were interviewed by an independent assessor who identified a group of patients in whom the role of gallstones in their presentation was uncertain (clinically possibly biliary group). All patients and controls underwent sincalide cholescintigraphy. The surgeons remained blinded to the study results throughout the study period. All patients were re-evaluated 6-12 months later to establish the ultimate diagnosis based on their therapeutic response.
Several parameters of gall-bladder function were studied from analysis of the sincalide cholescintigram. Lag time, ejection period, ejection rate and ejection fraction did not differ significantly among controls, patients proven to have non-biliary disease and patients proven to have biliary disease. There were significant differences in mean gall-bladder filling fraction between proven biliary and proven non-biliary groups. However, the group of patients with clinically possibly biliary symptoms could not accurately be separated into those who benefited from cholecystectomy and those who improved without surgery on the basis of this parameter.
Significant differences in gall-bladder filling fraction between symptomatic and asymptomatic gallstone patients were identified suggesting reduced gall-bladder compliance in symptomatic patients. However, the sincalide cholescintigram failed to emerge as a useful gall-bladder stress test. Even in the 1990s, assessment by an experienced surgeon appears to be the most appropriate way to select patients for cholecystectomy.
对因胆囊结石转诊至普通外科医生处治疗的患者进行研究，以评估辛卡利特胆囊闪烁扫描作为胆囊应激试验的作用，旨在识别出一组疼痛并非源于胆囊且胆囊切除术后病情不会改善的患者。
研究了10名无症状对照者和57名有胆囊结石及腹部症状的患者。由一名独立评估者对所有患者进行访谈，该评估者识别出一组胆囊结石在其症状表现中作用不确定的患者（临床可能为胆囊源性组）。所有患者及对照者均接受了辛卡利特胆囊闪烁扫描。在整个研究期间，外科医生对研究结果保持盲态。6至12个月后对所有患者进行重新评估，根据其治疗反应确定最终诊断。
通过对辛卡利特胆囊闪烁扫描图的分析，研究了胆囊功能的几个参数。对照者、经证实患有非胆囊源性疾病的患者和经证实患有胆囊源性疾病的患者之间，延迟时间、射血期、射血率和射血分数无显著差异。经证实为胆囊源性和非胆囊源性的两组患者之间，平均胆囊充盈分数存在显著差异。然而，根据该参数，无法准确地将临床可能有胆囊症状的患者分为受益于胆囊切除术的患者和未经手术病情改善的患者。
有症状和无症状胆囊结石患者之间的胆囊充盈分数存在显著差异，提示有症状患者的胆囊顺应性降低。然而，辛卡利特胆囊闪烁扫描未能成为一种有用的胆囊应激试验。即使在20世纪90年代，由经验丰富的外科医生进行评估似乎仍是选择胆囊切除术患者的最合适方法。
