内镜下软组织夹行十二指肠乳头成型术对Oddi括约肌功能恢复的影响

Effect of endoscopic endoclip papilloplasty on the function recovery of sphincter of Oddi

目的探讨内镜下软组织夹行十二指肠乳头成型术对Oddi括约肌功能恢复的有效性及安全性。方法前瞻性纳入2020年3月至2022年4月就诊于重庆医药高等专科学校附属第一医院的胆总管结石患者87例,随机将患者分为Oddi括约肌成型组(42例)和对照组(45例)。对照组采用十二指肠内镜下Oddi括约肌小切开+球囊扩张+胆总管取石+胆管支架植入术治疗,Oddi括约肌成型组在对照组相同治疗的基础上加行软组织夹Oddi括约肌成型术。术后随访1年,比较两组患者的Oddi括约肌基础压力、Oddi括约肌时相性收缩幅度、Oddi括约肌时相性收缩频率和术后总并发症发生率。结果术后6周,Oddi括约肌成型组括约肌的基础压力优于对照组[(25.1±9.4)mmHg vs(11.0±6.4)mmHg,t=8.089,P<0.001],时相性收缩幅度[(85.9±22.6)mmHg vs(58.2±17.6)mmHg,t=6.3383,P<0.001]和时相性收缩频率[(7.2±2.4)mmHg vs(4.0±1.4)mmHg,t=7.603,P<0.001]也均优于对照组;两组术后1年总并发症发生率差异无统计学意义(P>0.05)。结论内镜下用软组织夹行Oddi括约肌成型术能恢复Oddi括约肌的基础压力,能改善Oddi括约肌的时相性收缩幅度和时相性收缩频率,而且该方法不会增加术后总并发症发生率。

Objective To investigate the efficacy and safety of endoscopic endoclip papilloplasty on function recovery of sphincter of Oddi(SO).Methods From Mar.2020 to Apr.2022,we prospectively enrolled 87 patients diagnosed with choledocholithiasis at the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College.The patients were randomly divided into two groups:the endoclip papilloplasty group(n=42)and the control group(n=45).The control group underwent treatment that included a small incision of the SO,balloon dilatation,removal of common bile duct stones,and biliary stent implantation.The endoclip papilloplasty group received additional treatment of endoscopic endoclip for the SO plasty.After treatment,two groups were followed-up for 1 year.The base pressure,amplitude and frequency of the phasic contraction of SO,and incidence of total postoperative complications were compared between the two groups.Results Six weeks after treatment,the base pressure[(25.1±9.4)mmHg vs(11.0±6.4)mmHg,t=8.089,P<0.001],phasic contraction amplitude[(85.9±22.6)mmHg vs(58.2±17.6)mmHg,t=6.3383,P<0.001],and phasic contraction frequency[(7.2±2.4)mmHg vs(4.0±1.4)mmHg,t=7.603,P<0.001]of SO in the endoclip papilloplasty group were significantly higher than those in the control group.Follewed up for one year,there was no significant difference in the incidence rate of postoperative complications between the two groups(P>0.05).Conclusion Endoscopic endoclip papilloplasty can restore the base pressure of the SO,and improve its contraction amplitude and frequency without increasing the risk of postoperative complications.