胆囊切除术后合并胆管扩张患者肝胆动态显像参数分析及临床意义

摘要

Objective To observe the clinical significance of the changes of hepatobiliary dynamic imaging parameters in patients complicated with biliary dilatation following cholecystectomy. Methods Nine-teen patients undergoing elective cholecystectomy were enrolled and divided into the biliary dilatation group (n＝12)and non-biliary dilatation group (n＝7)according to the presence or absence of postoperative biliary dilatation. Six healthy subjects were assigned into the control group. All cases received fatty meal dynamic in-terventional hepatobiliary imaging. After the collection of the original images,the changes in the peak liver up-take time [Tmax(H)],half-emptying time in liver [T1/2(H)],and half-emptying time in common bile duct [T1/2(CBD)],common bile duct peak time [Tmax(CBD)],duodenal appearance time (DAT),he-patic to duodenal transit time (HDTT)and ratio of maximal target/non-target radioactivity of common bile duct were analyzed. Results No case showed any obvious discomfort after fatty meal intervention. No statistical significance was noted in the Tmax(H),T1/2(H),DAT and HDTT between any two groups of all three groups (all P＞0. 05). The T1/2(CBD),Tmax (CBD)and ratio of maximum target/non-target radioactivity of common bile duct in the biliary dilatation group were significantly higher compared with those in the non-bili-ary dilatation group (all P＜0. 05). No statistical significance was observed in these parameters between the non-biliary dilatation and control groups (all P＞0. 05). T1/2(CBD),Tmax(CBD),and ratio of maximum target/non-target radioactivity of common bile duct were of certain significance for the prediction of biliary dila- tation after cholecystectomy,and the areas under curve were 0. 740,0. 827 and 0. 917,respectively. Conclu-sions Patients complicated with bile duct dilatation after cholecystectomy present with significant changes in the biliary kinetic parameters. T1/2(CBD),Tmax(CBD)and ratio of maximum target/non-target radioactivity of common bile duct are significantly increased,the movement of duodenal sphincter is evidently inhibited and sphincter dysfunction occurs. Hepatobiliary dynamic imaging can provide evidence for the detection of Oddi's sphincter dysfunction.%目的 观察胆囊切除术后合并胆管扩张患者肝胆动态显像参数变化的临床意义.方法 选择19例择期行胆囊切除术患者,依据术后有无合并胆管扩张情况分为合并组(12例)和未合并组(7例),并选择同期6名健康体检者为正常组.均行脂餐介入肝胆动态显像处理,采集原始图像后分析肝脏高峰摄取时间[Tmax(H)]、肝脏半排时间[T1/2(H)]、胆总管半排时间[T1/2(CBD)]、胆总管高峰时间[Tmax(CBD)]、十二指肠显影时间(DAT)、肝门至十二指肠通过时间(HDTT)及胆总管最大靶/非靶放射性比值变化.结果 所有受检者在脂餐介入后均未出现明显不适反应.3 组受检者的Tmax(H)、T1/2(H)、DAT、HDTT两两比较差异均无统计学意义(P均 ＞0. 05 ),合并组患者的 T1/2 (CBD)、Tmax(CBD)、胆总管最大靶/非靶放射性比值均高于未合并组(P均＜0. 05 ),未合并组的上述指标与正常组比较差异无统计学意义(P均＞0. 05);T1/2(CBD)、Tmax(CBD)、胆总管最大靶/非靶放射性比值对胆囊切除合并胆管扩张均有一定诊断价值,曲线下面积分别为0. 740、0. 827、0. 917.结论 胆囊切除术后合并胆管扩张者胆汁动力学参数变化明显,T1/2(CBD)、Tmax(CBD)、胆总管最大靶/非靶放射性比值明显增高,十二指肠乳头括约肌运动明显抑制,括约肌功能紊乱,肝胆动态显像可为 Oddi's括约肌功能障碍检测提供依据.