大韓放射線醫學會誌 Vol. XX, No., 1984 캉셔 ιt * τ 떠 A x; %Z 써 7 상해영經口廳훌훌造影術上陽內結合型 Bilopaque (Conjugated Bilopaque) 出現의臨皮的意義 * 츄깐씨깡찍 ι)y) -Abstract- 혐明大學校醫科大學放射線科學敎室 ""/1) 1>' 기 金炳榮 金順植 金 洪 金玉培 全石놈 朴三均 김씬성?4 잉씨강 $ 깅 )l 써 γk71 1 까 λtf/ Clinical Significance of Presence of the Conjugated Bilopaque in the Bowel after Oral Cholecystography Byung Young Kim, M.D., Jung Sik Kim, M. D., Hong Kim, M.D., OK Bae Kim, M.D., Seok KiI Zeon, M.D., Sam Kyoon Park, M.D. Department of Radiology, Keimying University Medical College and Hospital, Taegu, Korea Oral cholecystography after ingestion of the. gr. Sodium tyropanoate (Bilopaque) was done in 54 patients from January 198 to August 198. Simple supine views of the abdomen of 7 patients, in whom the ga lj bladder was either nonvisualized or faintly visualized upto 17 hours after Bilopaque administration, were reviewed in search of th e presence of conjugated material in the bowel. The results were as follo ws: 1. The ratio of male to female was nearly :, and age distribution was even from years to 79 years.. Among 6 cases which showed conjugated Bilopaque in the bowel, cholecystitis with stone was cases (77% and acalculus cholecystitis was 6 cases (%).. Among 11 cases which showed no conjugated Bilopaque in the bowel, hepatitis was cases (8%) and clonorchis sinensis, salmonellosis, pancreatitis, acute gastritis was C<ises (1%) respectively. 4. AII of the cases of cholecystitis with stone showed conjugated Bilopaque.in the bowel. 5. Among 6 cases of which conjugated Bilopaque in the bowel, salmoneljosis was 1 case (17%) and remaining 5 cases (8%) were acalculus cholecystitis. 6. The results of our study show that the presence of conjugated Bilopaque in the bowel in nonvisualized or faintly visualized galj bladder after oral cholecystography is of definite indicative of cholecystitis. 7. Surgical intervention or ultrasonographic examination of the gall bladder without doubl e dose or second dose oral cholecystography on such cases is recommended * 이논문은 1984 년도계명대학교통산의료원임상연구보조비로이루어졌음. 이논문은 84 년 8 월 8 일에채돼되었음. - 64-
1. 絡論經口廳훌훌造影術은廳짧찢또는體石 1IË 談斷에있어서重要한放射線的方法中의하나이지만臨覆이보이지않거냐隔微하게나타날때는廳웰의異常有無判斷이상당히어려운境遇가많다. 그러나 Carios, Ami l 및 G eo rge 의報춤에依하면經口廳훌造影術에서 m쩔짧이보이지않거냐 fm 微하게보이면서 結合型 Bilopaque( ConjJgated Bilopaque ) 이陽內에나타나면二次經口體짧造影術을할必要없이 m쩔껑훌찢또는廳짧管閒銷에依한所見이라고報告하였다. 따라서 198 年 1 月부터 8 月까지著者들은혐明大學校醫科大學放射線科學敎室에서實施한經口觸짧造影術後陽內結合型 Bilopaque 의出現有無와廳훌훌愚과의相互關係를分析하여다음과같은成績을얻었기에文願考察과함께報告하는바이다 11. 對象및方法. 그람의 Bilopaque 를投與하여 17 時間後 m짤 11 寫합 에서脫짧이보이지않거나 fm 微하게보이논愚者가운데때 ( 立單純題部樞影上陽內結合型 Bilopaque의出現有無를 I앓認하고手術또는超音波檢흉等으로짧認이가능했던 7 例를對象으로하였다 ( Table N). 錫內結合型 Bilopaque 의出現判定基準은體 % (Pso. as muscle) 의陰影없度와比較하여더진하게나올때를陽性으로判定하였다 (Fig. I. II). m. 成續總 7 例中性別分布는男子가 15 例, 女子가 例 (67.5% ) 였으며年敵別分布는 歲에서 79 歲까지거의비슷한分布를보였다 (Table D. 全體 7 f71j 中 6 例에서陽內結合型 Bilopaque이보였으며이中廳石을同伴한擔짧찢이 例 (76.9%)(Fig. 1) 이며廳石을同伴하지않은健題찢이 5f7UC 19. % ) (Fig. ), 살모넬라폼이 I 例 (.8%) 였다 (Table 1D. 그리고結合型 Bilopaque 이陽內에서보이지않았던 11 例에서는땀찢이 쩌IJ Jff 吸蟲 íle. 에依한體製찢, 살모넬라효, 牌廳찢, 急性몹찢이各各 171J였다 (T a ble lll). Fig. 1. Conjugated Bilopaque in hepatic f1exure of colon, 17 hrs after oral administration. Laminated gall stone proved by ultrasonographic examination is noted. Fig.. Conjugated Bilopaque appears as a smooth homogeneous opacity in ascending colon with nonvisualization of gall bladder proved by surgical intervention ~ an acalculus cholecystit1s. - 65 -
Age (years) -9-9 4-4 9 5-59 6-69 7-79 Table 1. Age and Sex Disbribition Male 6 l Female 끼1-이ι τ< J 끼ι,l Aζu 끼jA아 l Table 11I. Final Diagnosis of the Patients with non Final Diagnosis Conjugated Bilopaque in Bowel Cho lecysti tis \ 씨 th clonorchis sinensis Hepatitis Pancreatitis Gastroenteritis Number 15 7 11 Table 11. Final Diagnosis* of the Patients with Conjugated Contrast Material in Bowel Final diagnosis Cholecystitis with stone Cholecystitis without stone *Confirmed by surgery or ultrasonographic examination Number (77%) 5 l ljf 吸蟲폼에依한廳훌훌 ~ 例에서는陽內結合型 Bi. lopaque 이보이지않았으며手術所見上寄生蟲이總輸 廳管을部分的으로閒銷시키고있었다고한다. w. 經口廳짧造影齊 j 로서 者들이彈調하여왔다. 考 察 6 Bi l opaque 이優秀하다고많은著 이들에의하면 Bilopaque 은陽에 서신속히吸收되고廳製에서充分히 U앓縮되므로서廳鍵을쉽게볼수있으며또한不作用이적교陽內에造影빼의殘홉가상당히적다고한다 Mechesney와 Hoppe등의땀究에서도 Bilopaque 이 Telepaque 보다훨씬더쉽게陽에서吸收된다고報告한바있다 Bilopaque이觸製에서보얼정도로充分한獨度를가지려면먼저상당量이陽에서吸收되어야하며맑에서結合이일어난後廳管으로分泌되어, 廳짧에서懷縮되어야한다. 따라서結合型 Bilopaque 이陽內에보일때는造影齊 j의充分한吸收, 正常的땀機能및廳道의開放을의미하게되며, 이때 m훨짧이보이지않 연廳鍵管의閒銷혹은觸鍵自體의짧縮能力에異常이있음을時事한다 Nathan 및 Newrnan 에依하연經口廳鍵造影術上 m뿔킹월이보이지않거나橋微하게보이는境遇, 單純題部寫륭上結合型 Bilopaque 이보이연廳道系外的인要因은거의排除할수있었으며全例에서 m쩔쩔g 管閒銷혹은廳짧찢으로談斷할수있었다고한다또한陽內에結合型 Bilopaque 이보이면 = 次經口廳짧造影術을할必要가없다고彈調하였다. 著者들의境遇에서도陽內結合型 Table IV. Final diagnosis and methods of confirmation Final diagnosis Surgery Methods Ultrasound Clinically Cholecystitis with stone Cholecystitis with c1ornorchis smensls Acalculus cholecystitis Hepatitis Pancreatitis Gastroenteritis 15 껴J 5 4)? ι14 끼/ ζu? ι꺼j? 18 8 11 7-66-
Bilopaque 이보였던 6 例中 5 例가 C 96%) 廳鍵찢으로 이지않거나 m 微하게 보이는證例中에서單純題部觸影 確認되었고다만 1 例에서는臨皮的으로살모넬라훈으로 上陽內結合型 Bilopaque 이 나타나며手術및超훌波檢 該斷되었다. 따라서經口廳짧造影術上 m 월짧이보이지않 흉로서確認可能한 7 例를分析하여다음과같은結果 거나橋微하게보이며結合型 Bilopaque 이陽內에나타 나는혈遇에는超훌波檢흉및臨뼈얀所見이廳앓월 ~ 과 플얻었키에文敵考察과함께報告하는바이다. 1). 7 例中에서女子가 例 ( 59.4%) 로서男子 15 一致하면곧장手術을動해도될것으로思料된다. 그러 例보다조금않았다. 나廳짧이보이지않고陽內에結合型 BilopaqJ e 이냐타 ). 年顧分布는 歲에서 79 歲로서비슷한分布를보 나지않으면땀機能障많및其他外的인原因을반드시 考慮해야한다. 였다. ). 陽內結合型 Bilopaque 이보였던 6 例에서는廳 陽內結合型 Bilopaque 의出現有無決定은 Nathan 과 石을同伴한 m 쩔짖필 ~ 例 C 77%), 體石을同伴하지않 Newman 等에의하면造影齊 j 服用前後의單純 L 題部용홉影 은廳짧찢이 6ØJJC %) 였다. 寫륨을比較하여할수있다고했으며 Carios, Ami l 과 George 等에의하면陽內와體節 CPsoas Mu scle) 의陰 影灌度를比較하여陽內의것이더진할때陽性으호認 定했다고한다. 그러나題햄像의 Bilopaque 보이는證例 에서는陽吸收障짧를推測할수있다고한다 C Fig. ). 4). 擔石을同伴하지않은 6 例中 5 例는非特異性體짧찢이었고 1 例는살모넬라효에依한것이였다. 5). 結合型 Bilopaque 이보이지않은 11 例에서는 ljf 찢이 例 C 8%) 이고.1Jf 吸蟲 jjë, 살모넬라jjË, H훌따훌찢, 急 性몹찢이各各 例 C 1%) 였다. V. 結 5ð. õl!!l 6). 廳石을同伴한廳짧찢 ØJJ 는全例에서結合型 Bilopaque 이陽에서보였다. 7). 經口健짧造影術 t 廳鍵이보이지않거냐 m 微하 19 8 年 1 月부터 8 月까지량明大學校醫科大學放射 게보이는證例에서는結合型 B ii opaque 의陽內出現有 線科學敎室에서經口廳짧造影術을섣시하여 m 혈製이 보 無를確認하여陽內出現이分明하연二次經口廳鍵術의 必要없이 @ 옆짧 ~ 또는擔짧管閒銷의 a~ 斷이可能하다. REFERENCES 1. Carios A. Muhletaler, MD, Amil J. Geriock, Jr. MD, and George R. Avant, MD Conjugated Sodium tyropanote (Bi/opaque) in the bowe/ : Significance of its presence or absence after First-dose ora/ cho/ecystography. Radi%gy 747:77-76, Nobember 7987.. Nathan MH, Newman A Conjugated iopanoic acid in sma// bowe/. 797. Radi%gy 79:545-548 Dec.. Benisek GJ, Gunn JA Pre/iminary c/inica/ eva/uation of new cho/ecystographic medium, Bi/opaque, Am J Roentgen%gy Radium ther Nuc/ Ned 88:97- OCt 796. 4. Moskowitz H. Milikow E, Osmun GP Sodium Trypanoate eva/uation of new ora/ cho/ecystographic agent. State J Med 7-77-74 75 Jan 797. 5. Mcchesney EW, Banks W F J R Urinary excretion Fig.. Granular appearance of non co 매 ugated Bilopa- of three ora/ cho/ecystographic agents in man. que in the bowel due to salmonellosis proc soc exp med 779: 77-7, Aug. Sep. 7965. - 67-
6. Mujahed Z. Evans JA, Whalen JP: The nonopaciηied gall bladder on orai cholecystography. Radiology 71:7- jul. 7974. 7. Dann D5, Rubin 5, Bauernfeind A : Significance of visualization of the common duct in the nonvisualized gall bladder AjR 8:776-779, Dec 7959. 8. 5tephens DH, Gisvold JJ. Carlson HC : Tomography of the gall bladder in oral cholecystography. Gastrointestinal radiol 7 :9-98, 7976. - 68-