内镜下十二指肠乳头括约肌切开术治疗Oddi括约肌功能障碍42例临床分析

Clinical Analysis of 42 Patients with Sphincter of Oddi Dysfunction Treated by Endoscopic Sphincterotomy

目的探讨内镜下十二指肠乳头括约肌切开术(EST)对Oddi括约肌功能障碍(SOD)的治疗价值。方法回顾性总结我院2005年8月至2009年5月期间按照RomeⅡ诊断标准筛选的42例SOD患者,B超、CT和MRCP排除胆管残留结石、肿瘤或其他胆管及胰管梗阻病变,对确诊为SOD的42例患者全部行EST。结果本组病例EST成功42例,成功率为100%。发生并发症5例(11.90%),均为急性胰腺炎,内科保守治疗3～7d后痊愈;无重症急性胰腺炎发生,无消化道穿孔、出血、胆管炎等其他严重并发症。随访12～45个月,平均23.8个月,全部病例腹痛症状均明显改善或缓解,有效率为100%,其中2例患者因高脂血症性胰腺炎发作返院行内科治疗痊愈。结论 EST治疗SOD由于疗效确切、痛苦小、安全、并发症少和可重复性,符合当今微创外科治疗的发展趋势,已成为SOD的首选治疗方法。

Objective To investigate the value of endoscopic sphincterotomy（EST） on treating sphincter of Oddi dysfunction（SOD）. Methods Forty-two patients with SOD according to Rome Ⅱ diagnostic criteria were retrospectively summarized.Bile duct residual stone,tumor or biliopancreatic duct obstruction diseases were excluded by B ultrasound,CT,and MRCP examination.Total 42 patients underwent EST. Results EST was done successfully in 42 cases,success rate was 100%.Postoperative acute pancreatitis occurred in 5 patients（11.90%）,which were cured by 3-7 d conservative treatment.There were no complications of severe acute pancreatitis,digestive tract perforation,hemorrhage,and cholangitis.Follow-up 12-45 months（mean 23.8 months）,symptoms of abdominal pain in all cases were improved or relieved,the effective rate was 100%.There were 2 cases treated conservatively because of hyperlipemic pancreatitis. Conclusion EST has become the primary treatment procedure for SOD because of definite outcome,less suffering,safety,less complications,and reproducibility,which are concordant with the requirements of minimally invasive surgery.