Oddi括约肌测压对胆囊切除术后腹痛患者的诊断价值

Endoscopic manometry in the diagnosis of sphincter of Oddi dysfunction

目的：探讨Ｏｄｄｉ括约肌测压对胆囊切除术后复发腹痛患者的诊断意义。方法：用低顺应性水灌注系统，三通道测压导管，观察Ｏｄｄｉ括约肌基础压、Ｏｄｄｉ括约肌基础收缩幅度、频率、传播方式和胆管内压。结果：胆囊切除术后患者，胆总管内压无明显差异（Ｐ＞０．０５），但Ｏｄｄｉ括约肌基础压力、Ｏｄｄｉ括约肌基础收缩频率及幅度均明显增高（Ｐ＜０．０１），Ｏｄｄｉ括约肌逆向性收缩的比例亦升高（Ｐ＜０．０５）。Ｏｄｄｉ括约肌测压异常发生率为４６．７％，其中Ⅰ型患者测压异常发生率为９０％，８０％表现为Ｏｄｄｉ括约肌狭窄，１０％为Ｏｄｄｉ括约肌运动功能紊乱；Ⅱ型患者测压异常发生率为３１．８％，Ｏｄｄｉ括约肌狭窄占１３．７％，功能紊乱占１８．１％；Ⅲ型患者测压异常发生率为６．７％，均表现为Ｏｄｄｉ括约肌运动功能紊乱。Ⅰ型患者测压异常发生率明显高于Ⅱ型及Ⅲ型患者。结论：Ｏｄｄｉ括约肌测压对研究Ｏｄｄｉ括约肌运动功能具有较高价值。

Objective:To evaluate endoscopic sphincter of Oddi manometry in the diagnosis of sphincter of Oddi dysfunction.Methods:A trip lumen low compliance system was used to record the sphincter of Oddi basal pressure, phasic contraction frequency, amplitude, direction of wave propagation, and common bile duct pressure.Results:Compared with control group, there was no difference in common bile duct pressure in study group, but the sphincter of Oddi basal pressure, phasic contraction frequency and amplitude were greatly higher(P< 0.01 ),and the proportion of negative wave propagation was also increased (P<0.05). The prevalence of manometric abnormalities was 46.7% among study group. The prevalence in type 1 which was higher than that in type Ⅱ or type Ⅲ(P<0.01) was 90%,including 80% with sphincter of Oddi stenosis and 10% with sphincter of Oddi dyskinesia. The prevalence in type Ⅱ was 31.8%,including 13.7% with sphincter of Oddi stenosis and 18.1% with sphincter of Oddi dyskinesia. While the prevalence in type Ⅲ was 6.7%, all were sphincter of Oddi dyskinesia.Conclusion:Sphincter of Oddi manometry has great value in the diagnosis of sphincter of Oddi dysfunction.