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Gallbladder motility in patients with hepatic cirrhosis before and after portal azygous disconnection. 2004
OBJECTIVE To determine and compare the effect of vagus nerve on gallbladder motility in patients with hepatic cirrhosis before and after portal azygous disconnection (PAD). METHODS PAD operation (or Hassab's operation) was performed on 18 patients with portal hypertension, and anterior and posterior vagal trunks were cut. On d 3 before operation and d 10 after operation, (99m)Tc-EHIDA 185 MBq was administered intravenously to the patients, and scintigraphy was performed at 0.25 min/frame. A standard fat meal was administered 30 min after scintigraphy, and dynamic imaging was performed 60 min after the fat meal. Following appearance of the region of interest (ROI) in gallbladder, the time-activity curve of ROI was established. The following seven parameters were used: radioactivity at 30 min after injection of (99m)Tc-EHIDA (RC 30 min), bile emptying fraction (EF), bile emptying period (EP), emptying rate (ER), latent period (LP), latent period radiocounting increment (LI), and latent period radiocounting increment rate (LR). RESULTS The RC 30 min decreased significantly after operation, compared with that before operation (2 693.6+/- 2 406.9 vs 5 606.8+/-2 625.4, P<0.05). The radiocounting of gallbladder increased gradually during LP. LP after operation was significantly longer than that before operation (13.36+/-5.92 vs 2.24+/-1.48, P<0.01). LI and LR after operation were significantly higher than those before operation (2 861.62+/-028.3 vs 331.21+/-421.02, and 113.42+/-49.52 vs 7.57+/-10.75, respectively, both P<0.01). EP after operation was significantly shorter than that before operation (18.5+/-6.3 vs 24.1+/-6.4, P<0.05). EF and ER after operation were significantly lower than those before operation (13.1+/-5.4 vs 32.3+/-16.3, and 0.7+/-0.3 vs 1.4+/-0.8, respectively, both P<0.01). CONCLUSIONS PAD operation is a good clinical model in studying the effect of vagus on gallbladder motility. The gallbladder tension after PAD operation decreases significantly during the interdigestive phase. The latent period of gallbladder contraction prolongs and the motility weakens apparently after a standard fat meal. Human vagus influences the gallbladder motility, and cutting of the nerve inhibits the gallbladder motility.
