^(99)Tc^m-DTPA直接肠道灌注检测肠胆反流

Detection of duodenal-biliary reflux in patients with T-tube after choledochotomy by ^(99)Tc^m-DTPA imaging

目的探讨用放射性核素检查判断T型管引流术后患者是否存在肠胆反流及其与Oddi括约肌运动功能之间的关系。方法胆道术后留有T型管患者78例,用^(99)Tc^m-DTPA判断是否存在肠胆反流,并根据结果将患者分为反流组及对照组,随机选取53例用胆道镜测量患者的十二指肠压(DP)、Oddi括约肌基础压(SOBP)、收缩波幅(SOCA)、收缩频率(SOF)、收缩间期(SOD)及胆总管压(CBDP)。结果78例患者中,有28例检测到十二指肠胆道反流(35．9%),反流组SOBP、SOCA、CBDP [分别为(-2．48±7．85)、(32．63±25．22)和(-1．34±5．18)mm Hg,1 mm Hg=0．133 kPa]明显低于对照组[分别为(11．65±10．88)、(91．54±63．21)和(6．38±7．26)mm Hg,P＜0．001]。结论Oddi括约肌运动功能不良与肠胆反流的发生密不可分。

Objective To detect the duodenal-biliary reflux in patients with T-tube after cholecystectomy and choledochotomy by ^99Tc^m-diethylene triamine pentoacetic acid （DTPA） imaging and to explore relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux. Methods Seventy-eight patients with T-tube after cholecystectomy were divided into reflux group and control group by measuring the amounts of radioactivity of ^99Tc^m-DTPA in the bile. Among them 53 were selected randomly and then underwent choledochoscope manometry. Sphincter of Oddi basal pressure （SOBP） , amplitude （SOCA）, frequency of contractions （ SOF）, duration of contractions （SOD） , duodenal pressure （DP） and common bile duct pressure （CBDP） were measured and analyzed. Results Duodenal-biliary reflux was detected in 28 patients （ 35.9% ）. SOBP, SOCA and CBDP in the reflux group [ （ - 2.48±7.85 ）, （ 32.63±25.22 ） and （ - 1.34±5.18） mm Hg, respectively, 1 mm Hg =0. 133 kPa]were much lower than in the control group [（11.65±10.88）, （91.54±63.21） and （6.38±7.26） mm Hg, respectively, P〈0.0011. Conclusion There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux.