放射性核素肝胆显像和超声在保胆手术患者中的应用价值

Application value of radionuclide hepatobiliary imaging and ultrasonography in patients undergoing gallbladder-preserving surgery

目的探讨放射性核素肝胆显像和超声在保胆手术患者中的应用价值。方法回顾性分析2017年6月至2017年12月在空军军医大学第二附属医院行腹腔镜联合硬质胆道镜探查取石术的40例胆囊结石患者临床资料。其中男16例,女24例;平均年龄(42±13)岁。患者均签署知情同意书,符合医学伦理学规定。患者均行锝依替菲宁(^(99m)Tc-EHIDA)放射性核素肝胆显像和腹部超声检查评估脂餐后胆囊的收缩功能。将超声测得胆囊收缩率在30%~60%的患者分为A组(30例),胆囊收缩率>60%的患者分为B组(10例)。两组患者放射性核素肝胆显像测得的胆囊排空指数(GBEF)比较采用t检验,两种检测方法相关性分析采用线性相关分析。以保胆手术是否成功作为金标准,采用ROC曲线比较两种检测方法的诊断效率。结果成功行保胆取石术33例,其中A组24例,B组为9例。A组和B组GBEF分别为(32±19)%、(61±11)%,差异有统计学意义(t=2.200,P<0.05);胆囊收缩率与GBEF成正相关(r=0.070,P<0.05)。GBEF诊断的ROC曲线下面积0.952,特异度0.88,敏感度1.00,准确率90%;胆囊收缩率诊断的ROC曲线下面积0.721,特异度0.55,敏感度0.88,准确率60%。两种方法的ROC曲线下面积比较差异有统计学意义(Z=3.299,P<0.05)。随访24个月,A组保胆患者未见胆囊结石复发,B组1例患者于术后20个月发现胆囊腔内结石复发。结论放射性核素肝胆显像能更好地评估胆囊收缩功能,且能评估胆道的通畅性;胆道通畅性受阻时,超声检测则更为可靠。放射性核素肝胆显像联合超声检查可为胆囊结石患者保胆取石手术提供较为可靠的依据。

Objective To evaluate the application value of radionuclide hepatobiliary imaging and ultrasonography in patients undergoing gallbladder-preserving surgery.Methods Clinical data of 40 patients with cholecystolithiasis who underwent laparoscopic and rigid choledochoscopic cholelithotomy in the Second Affiliated Hospital of Air Force Medical University from June to December 2017 were retrospectively analyzed.Among them,16 patients were male and 24 female,aged(42±13)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.All the patients received ^(99m)Tc-EHIDA radionuclide hepatobiliary imaging and abdominal ultrasound to evaluate the contractile function of gallbladder.According to the ultrasound results,patients with gallbladder contraction rate between 30%and 60%were assigned into group A(n=30)and those with gallbladder contraction rate>60%were allocated into group B(n=10).The gallbladder ejection fraction(GBEF)measured by radionuclide hepatobiliary imaging were compared by t test between two groups.The correlation between two detections was analyzed by linear correlation analysis.The success of gallbladder-preserving surgery was considered as the gold standard for diagnosis.The diagnostic efficiency of two methods were statistically compared by the ROC curve.Results 33 patients underwent gallbladder-preserving cholelithotomy successfully,including 24 cases in group A and 9 cases in group B.GBEF was(32±19)%in group A and(61±11)%in group B,where significant difference was observed(t=2.200,P<0.05).The gallbladder contraction rate was positively correlated with GBEF(r=0.070,P<0.05).The area under ROC curve(AUC)of diagnosis by GBEF was 0.952,the specificity was 0.88,the sensitivity was 1.00,and the accuracy rate was 90%.The AUC of diagnosis by gallbladder contraction rate was 0.721,the specificity was 0.55,the sensitivity was 0.88,and the accuracy rate was 60%.Significant difference was noted between two AUCs(Z=3.299,P<0.05).During the 24-month follow-up,no recurrence of gallbladder stones occurred in group A and 1 case of recurrence was reported in group B at postoperative 20 months.Conclusions Radionuclide hepatobiliary imaging can better evaluate the contractile function of gallbladder as well as the patency of biliary tract.Ultrasound examination is more reliable when the biliary tract is occluded.Radionuclide hepatobiliary imaging combined with ultrasound examination can provide more reliable reference for gallbladder-preserving cholelithotomy in patients with cholecystolithiasis.