Pallotta N, Corazziari E, Scopinaro F, Bonino R, Schillaci O, Vignoni A, Mangano M, Torsoli A
Cattedra di Gastroenterologia I, Clinica Medica II, DPT Medicina Nucleare, Università degli Studi di Roma La Sapienza, Italy.
Am J Gastroenterol. 1998 Oct;93(10):1877-85. doi: 10.1111/j.1572-0241.1998.00542.x.
The aim of this study was to assess whether a single noninvasive technique, ultrasonography, is able in vivo: 1) to evaluate the time-related patterns of gallbladder bile storage and emptying, and 2) to quantitate the amount of bile flux through the gallbladder (GB).
Healthy volunteers were submitted to the simultaneous assessment of gallbladder volume variations by frequent serial ultrasonographic (US) measurements and of hepatic bile flow through the GB by quantitative cholescintigraphy (QC) during continuous i.v. infusion of 99 mTc-HIDA. An ad hoc mathematical analysis of US GB volume measurements was used to estimate the amount of bile flux through the GB. The QC-derived measurements of the flux of hepatic bile through the GB was used to substantiate the US-derived estimates.
The curves expressing the time-related GB handling of hepatic bile obtained independently from US and QC measurements were statistically equivalent, and both techniques showed that the patterns and the amount of hepatic bile handled by the gallbladder after meal ingestion is remarkably different during three successive phases. After meals, hepatic bile was mainly 1) stored in the GB in the first phase; 2) emptied from the GB in a second phase; and 3) stored in the GB in the third phase. The ultrasonographic analysis estimated that 1) 23.8+/-12.5 ml (0.44+/-0.11 ml/min), 5.1+/-3.9 ml (0.15+/-0.10 ml/min), and 33.2+/-10.5 ml (0.53+/-0.16 ml/min) of hepatic bile entered into the GB during the three successive postprandial phases, and 2) the entire amount of bile flowing bidirectionally through the cystic duct, during the observation period (132.6+/-23.3 ml) was about five-fold greater than that estimated by the usually employed variables.
The proposed mathematical analysis of frequent ultrasonographic measurements of the GB volumes enables one to estimate noninvasively the flux of bile through the gallbladder in humans.
本研究旨在评估单一非侵入性技术——超声检查，在体内是否能够：1）评估胆囊胆汁储存和排空的时间相关模式；2）定量通过胆囊（GB）的胆汁流量。
在持续静脉输注99mTc-HIDA期间，对健康志愿者通过频繁的系列超声（US）测量同步评估胆囊体积变化，并通过定量胆闪烁显像（QC）评估通过GB的肝胆汁流量。对US测量的GB体积进行专门的数学分析，以估计通过GB的胆汁流量。通过QC得出的通过GB的肝胆汁流量测量值用于证实US得出的估计值。
分别从US和QC测量独立获得的表示肝胆汁与时间相关的GB处理情况的曲线在统计学上是等效的，并且两种技术均显示，在三个连续阶段中，进食后胆囊处理的肝胆汁模式和量有显著差异。进食后，肝胆汁主要在第一阶段：1）储存于GB中；2）在第二阶段从GB排空；3）在第三阶段储存于GB中。超声分析估计，在餐后三个连续阶段中，1）分别有23.8±12.5 ml（0.44±0.11 ml/min）、5.1±3.9 ml（0.15±0.10 ml/min）和33.2±10.5 ml（0.53±0.16 ml/min）的肝胆汁进入GB；2）在观察期内，双向流经胆囊管的胆汁总量（132.6±23.3 ml）比通常采用的变量估计值大五倍左右。
对GB体积进行频繁超声测量的拟议数学分析能够非侵入性地估计人体胆囊胆汁流量。
