放射性核素动态扫描计量分析对胆囊切除术后胆汁排泄的评价

Clinical study on the effect of cholecystectomy on human bile excretion and function of sphincter of Oddi with quantitative hepatobiliary scintigraphy (QHBS)

目的 探讨胆囊切除术对胆汁排泄的影响，寻找评价奥狄（ Ｏｄｄｉ） 括约肌功能的无创方法。 方法 将４５ 名自愿者病人随机分成３ 组，即术前组、术后组及排泄延迟组。经禁食８ ～１２ 小时后，分别静脉给予９ ９ ｍ Ｔｃ Ｅ Ｈ Ｉ Ｄ Ａ１８５ Ｍ Ｂｑ ，同时进行动态采集。取肝总管、胆总管、胆囊及十二指肠等部位的兴趣区（ｒｅｇｉｏｎ ｏｆｉｎｔｅｒｅｓｔ， Ｒ Ｏ Ｉ） ，通过实时的核素比值，分析单位时间的核素分布，同时比较胆总管兴趣区核素排泄的 Ｔｍａｘ 值。 结果 术前组与术后组比较，十二指肠与胆总管兴趣区的核素比值（ Ｒ２） 及胆总管 Ｒ Ｏ Ｉ的 Ｔｍａｘ 值差异无显著意义（ Ｐ＞ ００５） 。而排泄延迟组虽经 Ｂ 型超声检查证实无胆总管扩张，但其 Ｒ２ 值和胆总管 Ｒ Ｏ Ｉ的 Ｔｍａｘ 值与术前组对比差异有显著意义（ｔ１ ＝ ２１６ ，ｔ２ ＝ ２２９ ，ｔ３ ＝ ２０７ ， Ｐ＜ ００５） 。 结论 在没有肝外梗阻，无 Ｏｄｄｉ 括约肌功能失调的病人，其胆汁排泄于术前、术后无明显变化，胆囊切除术后胆总管无代偿性扩张。肝胆放射性核素动态扫描计量分析可作为 Ｏｄｄｉ 括约肌功能失调的诊断和分型的敏感、无创方法。

Objective To study the effect of cholecystectomy on human bile excretion and the function of sphincter of Oddi.Methods Forty five volunteer patients of biliary disease were divided into three groups,i.e. control group (20 cases),postoperative group (15 cases),and group of delayed bile excretion (10 cases).After an overnight fasting intravenous bolus of 185 MBq of 99m Tc EHIDA was given to each patient and quantitative hepatobiliary scintigraphy (QHBS) was performed on patients before or after cholecystectomy.The same size regions of interest(ROI) over common hepatic duct, common bile duct,gallbladder and duodenum were taken respectively. The ratio of nuclide between the different ROIs at the real time was calculated and the distribution of nuclide at real time analyzed. Results By t test,the ratio of outflow to inflow through sphincter of Oddi and peak time in time activity curve of the region of interest over common bile duct had not changed statisticaly. SPECT can find the abnormal bile excretion in patients with normal B US result. Conclusions Excretion of bile and function of Oddi sphincter had no change before and after cholecystectomy in patients without obstruction of biliary tract,nor there was a postoperative compensatory dilatation of the common bile duct. Quantitative hepatobiliary scintigraphy (QHBS) proved to be a useful non invasive method in the diagnosis and differentiation of the type of sphincter of Oddi dysfunction(SOD).