Tierexperimentelle Untersuchungen mit ^99mTc-Diäthyl-HIDA bei akutem komplettem Gallengangsverschluß^[*]

Zusammenfassung

Bei tierexperimentellem, akutem und komplettem Gallengangsverschluß kommt es bis 7 Wochen nach Ligatur des Ductus choledochus zu einer deutlichen EHIDA-Anreicherung im Leberparenchym, ohne daß ein Aktivitätsübertritt in den Darm erfolgt. Unmittelbar nach der Choledochusunterbindung stellt sich die Gallenblase als "heißer" Bezirk dar, während ab 1 Woche postoperativ die Gallenblasenregion als Aussparungsfigur im Leberparenchym erscheint. Aufgrund laborchemischer Ergebnisse und histologischer Befunde wird gefolgert, daß die auch bei mehrwöchiger Cholostase ausnahmslos zu beobachtende gute Leberparenchymanreicherung des EHIDA mit der geringen hepatozellulären Schädigung erklärt werden kann. Erst wenn es bei extrahepatischer Cholostase zu einem sekundären Parenchymschaden kommt, kann die EHIDA-Leberanreicherung praktisch aufgehoben sein.

Summary

In order to establish whether a complete obstructive jaundice can abolish the accumulation of diethyl-HIDA (EHIDA) in the liver parenchyma, the common bile duct was ligated in 14 mongrel dogs. Before as well as at regular intervals after ligature of the common bile duct, a sequence scintigraphy was performed with 2 mCi ^99mTc-EHIDA. For evaluation, time-activity curves (T_max, Tl/2), and analogue scintigrams as well as laboratory parameters were used for assessment. Up to seven weeks after ligation of the common bile duct, there was a marked accumulation of EHIDA in the liver parenchyma. The relative liver uptake (liver/background ratio) fell from 8.9 to 2.7, whereas conversely the cholestasis indicators aP and bilirubine rose markedly. T_max did not show any significant alterations, whereas T|/2 was prolonged from about one week after ligation. Because of the duct ligation, there was no excretion of activity into the intestines. Immediately after ligation of the common bile duct, the gallbladder was shown up as a "hot" area in which the majority of the applied activity appeared from about one hour p.i. Beginning with the fifth to the seventh day after ligation, the gallbladder was seen as a "cold" area in the liver parenchyma. Bilirubine and aP were raised by about 50 times the initial value. With longer lasting cholestasis, the scintigram no longer altered whereas bilirubine and aP rose further. Histological examination after ligation for more than five weeks showed slight alterations as a whole. Gamma-GT and in particular GPT were likewise slightly raised compared to bilirubine and aP. The conclusion was drawn from this that the good accumulation of EHIDA in the liver parenchyma which is to be observed without exception even in cholestasis lasting for several weeks could be explained by a relatively slight hepatocellular damage. Only when there is a consecutive parenchymal damage in extrahepatic jaundice, accumulation of EHIDA in the liver can be abolished.

^* Herrn Prof. Dr. Dr. h.c. C. Winkler zum 60. Geburtstag gewidmet.

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