Evaluation of Bile Flow Following Gastrectomy for Gastric Cancer by Hepatobiliary Scintigraphy

Takayoshi Akiyama, Keitarou Seto, Hitoshi Saitou, Masato Kiriyama, Fujio Tomita, Takeo Kosaka, Ichirou Kita, Shigeki Takashima

Department of General and Digestive Surgery, Kanazawa Medical University Medical

To clarify the etiology of cholelithiasis following gastrectomy for gastric cancer, we examined bile flow by^99mTc-N-pyridoxyl-5-methyltryptophan hepatobiliary scintigraphy. Four parameters were obtained: peak time of the right lobe of the liver, peak time of the left lobe of the liver, peak time of the common bile duct, and time of RI appearance in the duodenum. These parameters were determined in 22 patients who had undergone gastrectomy with R2 lymph-node dissection and cholecystectomy as treatment for gastric cancer (gastrectomy group), and 28 control patients who had undergone cholecystectomy for cholecystolithiasis or cholesterol polyps of the gallbladder. Every parameter was higher in the gastrectomy group than in the cholecystectomy group. In the gastrectomy group, the diameter of the common bile duct was correlated with the parameters obtained by hepatobiliary scintigraphy. These findings suggest that gastrectomy with lymph-node dissection causes delay of bile flow, contributing to the etiology of cholelithiasis following gastrectomy for gastric cancer. Moreover, the result that the diameter of the common bile duct was correlated with the delay of bile flow suggests that denervation due to lymph-node dissection might cause dysfunction of the sphincter of Oddi and the delay of bile flow.

Key words
choilithiasis following gastrectomy for gastric cancer, sphincter of Oddi, bile flow, ^99mTc-N-pyridoxyl-5-methyltryptophan, hepatobiliary scintigraphy

Reprint requests
Takayoshi Akiyama Department of General and Digestive Surgery, Kanazawa, Medical University, Medical
1-1 Daigaku, Uchinada, Kahokugun, Ishikawa, 920-02 JAPAN

Accepted
February 9, 1994

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