肝外胆管结石对Oddi括约肌功能的影响

Influence of extrahepatic bile duct stones on Oddi sphincter function

目的:探讨肝外胆管结石与O d d i括约肌(sphincter of Oddi,SO)压力的关系.方法:采用前瞻性研究方法,选取2013-01/2014-06南阳医学高等专科学校第一附属医院45例肝外胆管结石患者作为研究对象,根据术中情况,分为松弛组和不松弛组,根据手术次数,分为初发组和复发组.所有患者均采用胆总管切开取石T管引流术,术中进行胆道镜探查并进行SO测压.结果:SO松弛的发生率为40%(18/27).松弛组和不松弛组SO基础压(sphincter of O d d i b a s a l p r e s s u r e,S O B P)、S O峰压(sphincter of Oddi amplitude,SOAP)、SO收缩频率(frequency of sphincter of Oddi phasic contraction,SOF)、SO收缩持续时间(duration of sphincter of Oddi contraction,S O D)分别进行比较,差异有统计学意义(P<0.05).初发组S O松弛的发生率为25%(8/32),复发组为76.92%(10/13),两组进行比较,差异有统计学意义(P<0.05);初发组与复发组胆道镜相关指标进行比较,差异有统计学意义(P<0.05).结论:肝外胆管结石患者SO松弛的发生率较高,多次进行胆道手术可能是SO松弛的重要因素.

AIM： To explore the extrahepatic bile duct relationship between stones and the pressure of the sphincter of Oddi （SO） METHODS： Forty five patients with extrahepatic bile duct stones treated from January 2013 to June 2014 were retrospectively analyzed. According to the intraoperative situation, they were divided into relaxation and non-relaxation groups; according to the number of times of operation, they weredivided into primary and recurrent groups. All of the patients underwent choledocholithotomy and T tube drainage operation, and had intraoperative choledochoscope exploration and SO pressure measurement. RESULTS： The incidence of SO relaxation was 40% （18/27）. Sphincter of Oddi basal pressure （SOBP）, sphincter of Oddi amplitude （SOAP）, frequency of sphincter of Oddi phasic contraction （SOF） and duration of sphincter of Oddi contraction （SOD） differed significantly between the relaxation and non-relaxation groups （P 〈 0.05）. SO relaxation rate was 25% （8/32） in the primary group and 76.92% （10/13） in the recurrent group, and there was a significant difference between the two groups （P 〈 0.05）. CONCLUSION： Patients with extrahepatic bile duct stones have a high incidence of SO relaxation, and multiple biliary surgeries may be one of the important factors for the development of SO relaxation.