Hepatobiliyer sintigrafi yöntemi ile siroz hastalarinin safra kesesi motor fonksiyonlari ve safra dinamiklerinin degerlendirilmesi
Evaluation of gallbladder motor function and bile dynamics by hepatobiliary scintigraphy in patients with liver cirrhosis
- Ana Sayfa
- Sayılar
- Hepatobiliyer sintigrafi yöntemi ile siroz hastalarinin safra kesesi motor fonksiyonlari ve safra dinamiklerinin degerlendirilmesi...
Özet
Giris ve amaç: Karaciger sirozlu hastalarda hepatosit fonksiyonlari, safra kesesi motor fonksiyonlari ve safra dinamiginde meydana gelen degisiklikleri kantitatif hepatobiliyer sintigrafi yöntemi ile degerlendirmeyi amaçladik. Gereç ve yöntem: Çalismamizda hasta grubu klinik, laboratuvar ve histopatolojik olarak siroz tanisi konmus 17 olgudan ( 12 erkek, 5 kadin; ortalama yas:55,2 yil ) ve kontrol grubu ise 20 olgudan ( 14 erkek, 6 kadin; ortalama yas:49,7 yil ) olusmaktaydi. Bütün olgularda en az 8 saatlik açlik sonrasi 3-5 mCi Tc-99m-Mebrofenin iv yapildiktan sonra 90 dakika süreyle dinamik imajlar alindi. Vizüel olarak safra kesesi dolusu izlendigi görüntüde hastaya 250 ml standart sivi gida (Ensure plus) içirildi. Tüm görüntülerin bilgisayar yardimiyla incelenmesi sonucunda her olgu için radyofarmasötigin maksimum ekstrakte edilme zamani (Tmax), maksimum ekstrakte edilen radyofarmösitigin yarisinin ekskresyonu için geçen zaman (T1/2), safra kesesi ejeksiyon fraksiyonu (SKEF), safra kesesi vizüalizasyon zamani (SKVZ), safra kesesi dolma zamani (SKDZ) ve safranin duodenuma ulasma zamani (SDUZ) degerleri bilgisayar yardimiyla belirlendi. Bulgular: Tmax, T1/2max, SKVZ, SKDZ ve SDUZ degerlerinin ortalamalari hasta grubunda sirasiyla 25,76 dk, 37,55 dk, 25,23 dk, 53,35 dk, 39,88 dk, kontrol grubunda ise 12,40 dk, 23,15 dk, 16,82 dk, 30,57 dk, 25,00 dk olarak bulundu. Bu degerlerin siroz olgularinda anlamli derecede uzadigi görüldü (p < 0.05). Ortalama SKEF degeri hasta grubunda % 37,5, kontrol grubunda % 41,8 bulundu, siroz grubunda SKEF düsük olmasina ragmen her iki grup arasinda anlamli fark olmadigi görüldü (p > 0.05). Safra tasi görülme sikligi hasta grubunda % 29,4, kontrol grubunda % 5 olup aradaki fark anlamli ydi (p < 0.05). Sonuç: Karaciger sirozu olgularinda hepatobiliyer sintigrafi ile hepatosit alim fonksiyonunun azaldigi, safra dinamiginin bozuldugu ancak safra kesesi motor fonksiyonunda önemli bir degisikligin olmadigi saptandi. Ayrica sirozlu hastalarda safra kesesi tasi insidansi belirgin olarak arttigi ancak bunun safra dinamikleri ve safra kesesi motor fonksiyonunu etkilemedigi tesbit edildi.
Abstract
Background and aims: The aim of this study was to determine the changes in hepatocyte functions, gallbladder motor functions and bile dynamics in patients with liver cirrhosis. Material and methods: The study group consisted of 17 patients with liver cirrhosis (12 males, five females; mean age: 55.2 years) who were initially diagnosed on the basis of clinical, laboratory and histopathologic findings. The control group consisted of 20 healthy persons (14 males, 6 females; mean age: 49.7 years). Quantitative hepatobiliary scintigraphy was performed in both groups. After approximately eight hours of fasting, 3-5 mCi Tc99 m Mebrofenin was injected intravenously and dynamic images were obtained for 90 minutes. The patients were then given 250 ml. of standard liquid meal (Ensure plus) after observation of gallbladder filling. All images were evaluated quantatively by computer program. The time that the liver extracted the radiopharmaceutical maximally (Tmax), the time for the liver to secrete half of the extracted radiopharmaceutical (T1/2), gallbladder observation time (GBVT), gallbladder filling time (GBFT), gallbladder-ejection-fraction (GBEF) and the transit time of bile to the duodenum (TTBD) were determined for each case. Results: In the patient and control groups, the mean values of Tmax, T1/2, GBVT, GBFT and TTBD were 25.76 vs 12.40 min, 37.55 vs 23.15 min, 25.23 vs 16.82 min, 53.35 vs. 30.57 min, 39.88 vs 25.00 min, respectively. These values increased significantly in the patient group (p < 0.05). Mean GBEF values were 37.55% in the patient group and 41.84% in the control group, and the difference was not significant (p > 0.05). The incidence of a gallbladder stone was 29.41% in the patient group and 5% in the control group, with the difference being statistically significant (p < 0.05). Conclusions: In the patients with liver cirrhosis, it was found that hepatocyte uptake functions were decreased and bile dynamics had deteriorated, but there was no significant change in gallbladder motor function. Although the incidence of gallbladder stones was increased, it had no effect on bile dynamics and gallbladder motor function.
