Title: 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
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. 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. 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. 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. 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.