正常胰胆管汇合Oddi括约肌功能与胰液胆管逆流的关系

Function of Oddi＇s sphincter with normal pancreatobiliary confluence and pancreatobiliary reflux

目的探讨Oddi括约肌（SO）压力对胰液胆管逆流（PBR）的影响。方法对23例s0基础压力正常（正常组）、55例压力升高（升高组）和24例曾行EST（EST组）患者的SO基础压力值、胆汁淀粉酶（BA）检测结果及细菌培养结果进行对比分析。结果正常组和升高组在细菌培养阳性率、BA升高发生率及其BA值方面差异均无统计学意义（P〉0．05），升高组中SO压力与BA呈负相关，但胆总管直径≥15mm与〈15mm的BA值[中位数（四分位间距），4270（12337）U／L比279．5（1370）U／L]差异有统计学意义（P〈0．05）。EST组与完整乳头组（正常组＋升高组）在BA升高发生率[83．3％（20／24）比59．0％（46／78）]及细菌培养阳性率[75．0％（18／24）比33．3％（26／78）]方面差异均有统计学意义（P〈0．05）。结论s0基础压力升高与PBR无直接关联。但胆管直径显著增加时会导致BA值升高，对PBR的程度产生间接性影响；胰胆管高位汇合逆流程度明显，共同管长度可能与PBR的发生存在一定关联。而EST虽可引起PBR和胆汁细菌感染，但能减轻胆汁淤积，可能有利于逆流的胰液排出。

Objective To explore the impact of basal sphincter of Oddi （SO） pressure on pancre- atobiliary reflux （PBR）. Methods A total of 120 consecutive patients who received therapeutic ERCP for biliary tract diseases with or without the history of EST were enrolled, and were assigned to normal basal SO pressure group （n = 23 ）, elevated basal pressure group （ n = 55 ） and EST group （ n = 24）. Basal SO pressure, bile amylase （BA）and bacteria culture findings were compared between the three groups. Results There were no differences in positive rate of bacteria culture, SO pressure increase and BA between the normal basal SO pressure group and elevated basal pressure group. In the latter group, negative correlation was observed between SO pressure and BA. The BA value [ median（ quartile range） ] in patients with common bile duet I〉 15 mm [4270 （12 337）U/L] was significantly higher than that in patients with common bile duct 〈 15 mm [ 279. 5 （1370）U/L]. Furthermore, significant difference in both the proportion of elevated BA patients （83.3% vs. 59.0% ） （P 〈0.05） and the positive rate of bacteria culture （75.0% vs. 33.3% ） was seen between the intact papilla patients in the former two groups and those in EST group （P 〈 0. 05 ）. Conclusion There was no direct correlation between the elevated basal SO pressure and PBR, but marked increase in diameter of common bile duct can lead to a rise in BA. Moreover, although EST can bring about PBR and bile bacterial infection, it may facilitate the outflow of the refluent pancreatic juice by relieving eholestasis.