胆汁排空时间及奥狄括约肌蠕动方向与胆囊切除后胆源性腹痛关系探讨

Relationship of bile evacuation time and Oddi sphincter peristalsis direction with biliary pain after cholecystectomy

目的探讨胆汁排空时间及奥狄括约肌(SO)蠕动方向与胆囊切除术后胆源性腹痛之间的关系。方法对32例胆囊切除术后胆源性腹痛患者行内镜下逆行胰胆管造影(ERCP)检查,需行十二指肠乳头括约肌切开者则行内镜下十二指肠乳头括约肌切开术(EST);观察造影剂排空时间、胆管SO蠕动方向、胆胰管末端进入十二指肠的类型、胆总管远端生理狭窄段(NDS)长度。结果32例胆囊切除后胆源性腹痛患者,造影剂排空时间≥45分钟者25例,有SO蠕动方向改变者24例,NDS≥10mm者23例;24例SO蠕动方向改变者中逆向蠕动11例,同步收缩13例;23例NDS≥10mm患者中21例造影剂排空时间>45分钟。结论胆汁排空时间延长及SO蠕动方向异常是胆囊切除术后胆源性腹痛的重要原因,而胆汁排空时间延长及SO蠕动方向异常与NDS过长明显相关。

Objective To investgate the relation of bile evacuation hour and Oddi sphincter peristalsis heading with biliary pain after cholecystectomy.Methods Thirty-two patients with biliary pain after cholecystectomy underwent endoscopic retrograde (cholangiopanereatography(ERCP)) test.The patients whose duodenal papilla sphincter needed dissections underwent the endoscopic sphincterotomy(EST).Then observation was made on their bile evacuation time,peristalsis heading of bile duct Sphincter of Oddi(SO),the style of gallbladder pancreatic duct terminal accessing duodenal,physiological narrow distal segment(NDS) length of choledochus.Results There were 25 cases of 32 patients with biliary pain after cholecystectomy whose evacuation hour was ≥45 minutes;and 24 showed SO peristalsis heading changes;23 of them whose NDS length was ≥10 mm.And meantime 11 of 24 cases whose SO peristalsis heading changes displayed converse peristalsis;13 of 24 patients displayed synchronization shrinkage.21 of 23 patients whose NDS length was not shorter than ≥10 mm displayed bile evacuation time >45 minutes.Conclusion Bile evacuation time expanding and SO peristalsis heading abnormalty are the main causes which lead to biliary pain after cholecystectomy.Whereas bile evacuation time expanding,SO peristalsis heading abnormality and NDS overlength are mainly connected with biliary pain after cholecystectomy.