A PROSPECTIVE STUDY OF FUNCTIONAL ASSESSMENT OF POSTOPERATIVE CHANGES OF THE GALLBLADDER IN THE EARLY PERIODS OF FOLLOWING GASTRECTOMY FOR GASTRIC CANCER BY ULTRASONOGRAPHY AND HEPATOBILIALLY SCINTIGRAPHY

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  • KUSUYAMA Akira
    Department of Surgery, Daisan Hospital, The Jikei University School of Medicine
  • MITSUMORI Norio
    Department of Surgery, Daisan Hospital, The Jikei University School of Medicine
  • WAKABAYASHI Mari
    Department of Surgery, Daisan Hospital, The Jikei University School of Medicine
  • KOMURO Keiji
    Department of Surgery, Daisan Hospital, The Jikei University School of Medicine
  • ANDO Hiroshi
    Department of Surgery, Daisan Hospital, The Jikei University School of Medicine
  • ITSUBO Kihachirou
    Department of Surgery, Daisan Hospital, The Jikei University School of Medicine

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  • 胃切除術後早期の胆嚢機能評価に関する検討(第1報)

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Abstract

In 30 patients following curative gastrectomy for gastric cancer in our institution, functional assess-ment (about (1) maximal fasting area (2) maximal contraction rate (3) presence of gallstones and debris echoes) at the gallbladder was made serially before, and 2, 4 weeks and 6 months after the operation by ultrasonography, and bile flow assessment was done 4 weeks after the operation by 99mTc-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) hepatobiliary scintigraphy, to clarify the etiology of postoperative cholecystolithiasis.<br> By ultrasonography, significant enlargement and contractile dysfunction of the gallbladder was found in 29 patients except one patient who had undergone pylorus preserving gastrectomy (PPG), compared with preoperative values. However, these findings recovered gradually thereafter.<br> Debris echoes were visualized in 17 (58.6%) in 2 weeks, and in 14 (48.3%) in 4 weeks out of 29 patients. Transition from debris echoes to gallstones was comfirmed in only 2 (6.9%) of these 29 patients within 4 weeks. However, these findings disappeared gradually thereafter.<br> By hepatobiliary scintigraphy, we found a delayed tendency of bile flow of gallbladder, peak time of the common bile duct and time of RI appearance in the duodenum, and regurgitation of bile flow to intrahepatic duct after caerulein injection (0.2μg/kg i.m.) in 7 (24.1%) out of 29 patients except one patient with PPG in addition to dysfunction of gallbladder in 4 weeks.<br> It is concluded that denervation due to gastrectomy with lymph node dissection might cause dysfunc-tion of the sphincter of Oddi, especially failure of coordinated movement between the sphincter of Oddi and gallbladder, in addition to dysfunction of the gallbladder in an early period after gastrectomy for gastric cancer.

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