rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2015-0-6-107-113rentrad-87Research ArticleСтатьиДиагностика недостаточности сфинктера Одди у больных с постхолецистэктомическим синдромом по данным гепатобилисцинтиграфииDiagnosis of sphincter of Oddi dysfunction in patients with postcholecystectomy syndrome from hepatobiliary scintigraphic findingsРепинМ. В.RepinM. V.

д. м. н., профессор кафедры хирургии

MD, PhD, DSc, Professor of the Department of Syrgery

МикрюковВ. Ю.MikryukovV. Yu.

хирург

Syrgeon

ВагнерТ. Е.VagnerT. E.

к. м. н., радиолог

MD, PhD, Radiologist

ПлешковаН. М.PleshkovaN. M.

к. м. н., доцент кафедры лучевой диагностики и лучевой терапии

MD, PhD, Associate Professor of the Department of Radiation Diagnosis and Radiotherapy

ГБОУ ВПО «Пермский государственный медицинский университет им. акад. Е.А. Вагнера» Министерства здравоохранения РФРоссияE.A. Vagner Perm State Medical University, Ministry of Health of the RFRussian FederationГБУЗ «Пермская краевая клиническая больница» Министерства здравоохранения Пермского краяРоссияPerm Regional Clinical Hospital, Ministry of Health of the Perm RegionRussian Federation2015090320160655Copyright © Репин М.В., Микрюков В.Ю., Вагнер Т.Е., Плешкова Н.М., 20162016Репин М.В., Микрюков В.Ю., Вагнер Т.Е., Плешкова Н.М.Repin M.V., Mikryukov V.Y., Vagner T.E., Pleshkova N.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/87

Цель исследования – диагностика и оценка клинического значения недостаточности сфинктера Одди у больных после холецистэктомии.

Материал и методы

Материал и методы. Обследованы 100 больных после холецистэктомии без признаков холестаза, из них 14 пациентов с папиллотомией были включены в группу сравнения. Проведена гепатобилисцинтиграфия с применением радиофарм-препарата 99mТс-бромезида в течение 90 мин, с желчегонным завтраком на 45-й мин. Оценивали функциональное состояние общего желчного протока, двенадцатиперстной кишки (ДПК) и дуоденогастральный рефлюкс (ДГР), сопоставляя с данными клинических, лабораторных и инструментальных исследований.

Результаты

Результаты.Подинамике желчеоттока выделены две группы больных. В 1-й группе у 20 (23,2%) больных время максимального накопления (Тmax) радиофармпрепарата в холедохе совпадало с желчегонным тестом – 46,0 ± 1,8 мин, а во 2-й группе у 66 (76,8%) больных Тmax наступало ранее желчегонного теста – 32,9±6,8 мин (р<0,05). Во 2-й группе Тmax было схоже с данным показателем в группе сравнения (30,9±7,5 мин; р>0,05), кроме того, между этими группами не было достоверного отличия по времени визуализации кишечника (18,6±6,0 против 17,6±0,8 мин), что позволило сделать заключение о недостаточности сфинктера Одди. У 73% больных с недостаточностью сфинктера Одди и у 86% больных в группе сравнения наблюдается диарея, у больных с нормальным пассажем желчи (р<0,01) она отмечена в 10% случаев. Статистическая обработка данных свидетельствует о корреляции показателей недостаточности сфинктера Одди с показателями эвакуаторной функции ДПК (r=0,57; р<0,0005) и ДГР (r=0,74; р<0,009).

Заключение

Заключение. Недостаточность сфинктера Одди после холецистэктомии наиболее выраженное клиническое значение приобретает у больных с нарушениями моторно-эвакуаторной функции ДПК, что следует учитывать при выборе лечебной тактики.

 

 

Objective

Objective: to diagnose and estimate the clinical value of postcholecystectomy sphincter of Oddi dysfunction in patients.

Material and methods

Material and methods. Examinations were made in 100 postcholecystectomy patients without signs of cholestasis; of them 14 postpapillotomy patients formed a comparison group. Hepatobiliary scintigraphy using the radiotracer 99mTC-bromeside was performed for 90 minutes with cholagogue breakfast at 45 minutes. Common bile duct and duodenal functions and duodenogastric reflux (DGR) were evaluated comparing them with clinical, laboratory, and instrumental findings.

Results

Results. Two patient groups were identified according to bile outflow changes. In Group 1 consisting of 20 (23.2%) patients, the time of maximum accumulation (Tmax) of the radiopharmaceutical in the projection of the choledochus coincided with that in the cholagogue test (46.0±1.8 min) and in Group 2 including 66 (76.8%) patients that was shorter than in the cholagogue test (32.9±6.8 min) (p<0.05). In Group 2, Tmax was similar to that in the comparison group (30.9±7.5 min; р>0.05) and there was no significant difference in intestinal imaging time (18.6±6.0 min versus 17.6±0.8) either, which could be indicative of sphincter of Oddi dysfunction. Diarrhea was observed in 73% of the patients with sphincter of Oddi dysfunction and in 86% of the patients in the comparison group versus 10% of the patients with normal bile passage (p<0.01). Statistical data processing showed a correlation of the indicators of sphincter of Oddi dysfunction with those of duodenal evacuator function (r=0.57; p<0.0005) and DGR (r=0.74; p<0.009).

Conclusion

Conclusion. Postcholecystectomy sphincter of Oddi dysfunction assumes the greatest clinical value in patients with duodenal motor-evacuator dysfunction, which should be kept in mind when choosing a treatment policy.

 

 

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The authors declare that there are no conflicts of interest present.