十二指肠乳头括约肌松弛性病变处理策略

TREATING LAXATION PATHOLOGICAL CHANES OF SPHINCTER OF DUODENAL PAPILLA

目的提高对十二指肠乳头括约肌（以下称Oddi括约肌）松弛性病变的诊治水平。方法我院从1996年7月～2005年7月，对有反复急性胆管炎发叙及多次胆道手术患者，采用序贯性B超、上消化道造影和纤维胆道镜检测Oddi括约肌关闭径、开放经等措施，诊断Oddi括约肌松弛性病变。诊断明确者行胆管空肠Roux-en-y吻合术（以下称胆肠吻合术）或胃肠吻合术。本文总结48例临床资料。结果本组诊断为Oddi括约肌松弛性病变48例，均有反复多次急性胆管炎发作史，至少1次胆道外引流手术史。行Ⅰ期胆肠吻合术25例，Ⅱ期胆肠吻合术10例；Ⅰ期胃肠吻合术6例。7例放弃胆肠吻合手术。均获I疆访，随访6月～8年，行胆肠吻合术35例中，5例术后第一年发生急性胆管炎1～2次，都经短暂抗感染治疗后获愈。行胃肠吻合术6例中，2例分别于术后3,6月发生吻合口溃疡，经正规制酸治疗后获愈。未行胆道改道手术7例中3例死亡，1例死于胆汁性肝硬化并上消化道大出血，1例死于急性重症胆管炎，1例死于胆管癌。结论Oddi括约肌松弛性病变并不少见，根据病史，配合以纤维胆道镜为主的系统检查可正确诊断，一经诊断，果断行胆肠吻合术。

Objective Improving diagnosing and treating level in the laxation patholoical changes of Oddi＇s sphincter. Methods For diagnosingthe the laxation patholoical changes of Oddi＇s sphincter , from Jul. 1996 to Jul. 2005 we adopted examinations including B-ultrasound, contrast radiography of upper digesive track, measuring closing track and opening track of Oddi＇s sphincter by choledochoscope, etc, for the patients who were suffering from repeating operations of bile and acute cholangitis with repeated paroxysm. Those wlio thought definitely for the above symptoms were treated with cholangio-jejunostomy or gastrojejunostomy. The paper has been written on the basis of 48 cases clinical data. Results Of the group 48 cases were diagnosed as the laxation pathological changes of Oddi＇s sphincter, having repeated paroxyam recod of acute cholangitis without exception, at least one time of being treated with hepatocholangiostomy. 25 cases teated with cholangio-jejunostomy and 6 cases teated with gastrojejunostomy in I phase, 10 cases teated with cholangio-jejunostmy in 11 phase. 7 cases were givien up. All the above cases were followed-up survey from 6 months to 8 years. 5 cases treated with cholangio-jejunostomy ailed from acute cholangitis one or two times in first year after operation and cuered trough short period of anti-infection treatment. 2 cases treated with gastrojejunostomy hapepened with gastric ulcer were cured. Of the 7 cases 3 died without treating with cholangio-jejunostomy or gastrojejunostomy. 1 case died of acute serius cholangitis 1 case of bile duct cancer, 1 case of hepatocirrhosis with massive haermorrhage of upper digestive duct. Conclusion It was often seen with laxation pathological changes of Oddi＇s sphincter among the patients and going on the history and helped by choledochoscope the correct diagnosis may be reached and upon diagnosing cholangi-jejunostomy should be decidedly made.