| IntroductionThe "gold standard" of diagnosing SOD is endoscopic sphincter of Oddi manometry, but it is not widely used because it is invasive, expensive and there are more complications after examination. Hepa-tobiliary scintigraphy can give us quantitative parameters of bile emptying and it is a noninvasive, sensitive and accurate method in diagnosing SOD. The bile dynamics after cholecystectomy was seldom studied , the aim of this study is to obtain the normal changes of bile emptying after cholecystectomy by hepatobiliary scintigraphy and provide basis for diagnosing SOD.ObjectiveQuantitative hepatobiliary scintigraphy, a noninvasive method used to diagnose dysfunction of bile duct, can show bile secretion and outflow in bile duct. The goal of this study was to examine the dynamics of bile secretion and outflow by quantitative hepatobiliary scintigraphy in patients with gallstones, patients after cholecystectomy and normal controls, got the parameters of normal changes of bile emptying in patients after cholecystectomy and to help diagnosing SOD.MethodPatients: 31 patients with gallstones, demonstrated single or multiple gallstones by abdominal ultrasonography; 12 normal controls and 12 patients after cholecystectomy. They were all ruled out liver diseases and bile duct stones by liver function tests and US respectively, the diameter of common bile duct was normal, liver functions were normal and there were not symptoms of bile duct diseases.Method; all the patients were examined by fatty meal augmentation hepatobiliary scintigraphy according to the same method. After fasting over 4 hours , 740MBq 99mTc - EHIDA was injected intravenously . Images were recorded continuously at one frame per minute for 100 minutes; at 60th minute two fry eggs were taken. Then the parameters of bile emptying (Tmax in liver and common bile duct,T1/2 in liver and common bile duct, time of duodenal appeared (DAT) , transit time from liver to duodenal ( HDTT) and half - emptying time in common bile duct after fatty food augmentation ( T' 1/2) , the appearance time of gallbladder( T ) )were calculated and then compared.ResultsDAT and HDTT in patients after cholecystectomy decreased ( P < 0. 05) in comparison with normal control group, Tmax in liver and common bile duct,T1/2 in liver and common bile duct showed no difference in comparison with normal control group (P >0. 05) ; T 1/2were significantly decreased than T1/2 in common bile duct in normal control group and the group after cholecystectomy ( P < 0. 001 respectively) ;DAT, HDTT, Tmax and T1/2in CBD in the group after cholecystectomy showed significant difference in comparison with gallstone group, ( P < 0. 001 respectively); Tg and GBEF of gallbladder in gallstone group showed significant difference in comparison with normal control group(P< 0.001 respectively) , DAT, HDTT, Tmax and T1/2in CBD in gallstone group were different from normal control group (P < 0.05 respectively ).DiscussionIn this study all the patients after cholecystectomy had not symptoms of bile duct diseases. The purpose of this study was to obtain normal changes of bile emptying after choleccystectomy, so we can provide basis for diagnosing SOD.The hepatic bile excretion and the pressure of CBD were normal in normal control group, the variation of T1/2 was very little. In the gallstone group, because of the dysfunction of the gallbladder the coordination between gallbladder and SO was destroyed, the T1/2 of hepatic bile excretion was longer than that of normal control. After cholecystectomy , without the periodic filling and emptying periods of the gallbladder , the actual phase of the duodenal migrating motor complex has probably no or only a minor influence on the bile emptying rate, the hepatic bile emptying in patients without gallbladder changes a little.For the patients with a gallbladder in situ, the filling of gallbladder began at the intervals of digestion. The appearance time of gallbladder in normal control group was earlier than the gallstone group, the... |
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