放射性核素肝胆显像对腹腔镜联合硬镜微创保胆取石术前胆囊收缩功能的评估作用

Role of 99mTc-EHIDA hepatobiliary scintigraphy in the eraluation of gallbladder contraction function before laparoscopic-hard endoscopic gallbladder-preserving cholecystolithotomy

目的探讨放射性核素肝胆显像在评估胆囊收缩功能中的作用,为腹腔镜联合硬镜保胆取石患者术前评估胆囊收缩功能提供理论依据。方法 选取2016年6月-12月就诊于空军军医大学第二附属医院且行锝依替菲宁注射液( 99m Tc-EHIDA)肝胆显像评价胆囊收缩功能的胆囊结石患者47例,检测脂餐后胆囊放射性计数并依次计算胆囊收缩功能,结合术中探查情况及最终保胆结果,对二者之间的评估情况进行比较分析。结果 26例EHIDA提示胆囊收缩试验阴性患者均顺利实施了保胆手术,且该部分患者随访24个月未见结石。12例EHIDA提示胆囊收缩功能不同程度受损的患者,有1例因胆囊内壁毛糙并大量胆固醇结晶沉积,给予胆囊切除;余下11例患者均行保胆取石术。9例胆囊始终未见显影患者中,1例术中探查发现直径约2 cm结石嵌顿于胆囊颈部,实施保胆手术,随访24个月未见胆囊结石复发;余下8例患者均行胆囊切除。结论 放射性核素肝胆显像在评估胆囊收缩功能试验中有一定的价值,但不能作为选择手术方式的唯一证据,腹腔镜联合硬镜的术中探查是决策保胆取石术最有力的证据,值得制订更加规范的行业标准。

Objective To investigate the role of radionuclide hepatobiliary scintigraphy in the evaluation of gallbladder contraction function, and to provide a theoretical basis for preoperative evaluation of gallbladder contraction function in patients undergoing laparoscopic-hard endoscopic gallbladder-preserving cholecystolithotomy. Methods A total of 47 patients with gallstones who were admitted to The Second Affiliated Hospital of Air Force Medical University from June to December, 2016, and underwent 99m Tc-EHIDA hepatobiliary imaging to evaluate gallbladder contraction function were enrolled. The radioactive count of the gallbladder was measured after fat meal and gallbladder contraction function was evaluated. A comparative analysis was performed based on intraoperative exploration and gallbladder-preserving outcome. Results A total of 26 patients with negative results of the EHIDA gallbladder contraction test underwent a successful gallbladder-preserving surgery, and some of them had no recurrence of stones after 24 months of follow-up. Among the 12 patients with impaired gallbladder contraction function shown by EHIDA, 1 underwent cholecystectomy due to roughness of the gallbladder wall and deposition of a large amount of cholesterol crystal, and 11 underwent gallbladder-preserving cholecystolithotomy. Among the 9 patients without the image of the gallbladder, 1 was found to have stones with a diameter of 2 cm embedded in the neck of the gallbladder by intraoperative exploration and underwent gallbladder-preservation surgery, and no recurrence of gallbladder stones was observed after 24 months of follow-up;the remaining 8 patients underwent cholecystectomy. Conclusion 99m Tc-EHIDA hepatobiliary scintigraphy has a certain value in evaluating gallbladder contraction function, but it cannot be used as the only evidence for the selection of surgical approach. Laparoscopic-hard endoscopic intraoperative exploration is a strong evidence for the selection of gallbladder-preserving surgery, and formal industry standards can be developed.