随着内镜下,术中或经T管oddi括约肌测压技术出现,人们对oddi括约肌(sphincter of oddi,SO)的生理与病理生理有了深入的了解,Oddi括约肌运动功能障碍(sphincter of oddi dysfunction,SOD)已被大部分学者接受。SOD是由于SO运动障碍或良性...随着内镜下,术中或经T管oddi括约肌测压技术出现,人们对oddi括约肌(sphincter of oddi,SO)的生理与病理生理有了深入的了解,Oddi括约肌运动功能障碍(sphincter of oddi dysfunction,SOD)已被大部分学者接受。SOD是由于SO运动障碍或良性狭窄引起的功能失调,但目前很难在组织学水平研究人体SO,故很难将功能性紊乱与器质性改变区分开。SOD的诊断有赖于临床表现、生化测定、激发试验、超声扫描、ERCP、SO测压等多种检查方法,采用单一方法诊断SOD并不可靠。目前SOD到底是解剖上的病变或生理学上的功能障碍尚不明确固治疗SOD的方法多样化,主要药物治疗、内镜治疗、外科手术,但至今,没有一套完善的治疗方法.寻找新的安全、简便、有效的治疗方法,是一项比较艰巨的任务。目前学者探寻肉毒毒素作用于SO,以期能主动调节SO有规律收缩舒张,使其处于一个相对稳定的状态,以维持SO的生理功能。展开更多
2005年7月—2008年8月我院对32例Oddi括约肌功能障碍（sphincter of oddi dysfunction,SOD）患者行内镜下十二指肠乳头括约肌切开治疗,治疗过程中对胆汁淀粉酶（amylase,AMS）进行了检测,发现胆汁AMS增高对SOD的诊断具有一定的价值．总...2005年7月—2008年8月我院对32例Oddi括约肌功能障碍（sphincter of oddi dysfunction,SOD）患者行内镜下十二指肠乳头括约肌切开治疗,治疗过程中对胆汁淀粉酶（amylase,AMS）进行了检测,发现胆汁AMS增高对SOD的诊断具有一定的价值．总结报道如下。展开更多
胆总管末端Oddi括约肌功能状态是普外科临床的一个重要课题,现已引起临床医师们的关注。Oddi括约肌功能障碍（sphincter of oddi dysfunction,SODF）是指Oddi括约肌失去正常生理功能,出现上腹部胆胰源性疼痛、餐后腹胀、肝或胰酶升高、...胆总管末端Oddi括约肌功能状态是普外科临床的一个重要课题,现已引起临床医师们的关注。Oddi括约肌功能障碍（sphincter of oddi dysfunction,SODF）是指Oddi括约肌失去正常生理功能,出现上腹部胆胰源性疼痛、餐后腹胀、肝或胰酶升高、胆总管扩张或胰腺炎发作等一系列临床症状。展开更多
Aims-Pain recurrence after cholecystectomy is often attributed to sphincter of Oddi dysfunction, whose diagnostic criteria and treatments remain uncertain. We performed a retrospective study to assess the possible pre...Aims-Pain recurrence after cholecystectomy is often attributed to sphincter of Oddi dysfunction, whose diagnostic criteria and treatments remain uncertain. We performed a retrospective study to assess the possible precipitating role of opiate ingestion in this setting. Methods-The retrospective study of the files of 147 consecutive patients investigated for post-cholecystectomy syndrome by endoscopic ultrasonography and/or endoscopic retrograde cholangiography yielded 37 cases of suspected biliary-type sphincter of Oddi dysfunction. Results-Thirteen patients (30%) with suspected sphincter of Oddi dysfunction had taken opiate-containing drugs 15 minutes to two hours (median 1 hr) before the onset of pain (“Opiate group“). When compared with the 23 patients having not taken opiates (“Non Opiate Group“), they were significantly younger (47 vs. 60 yrs), had a narrower common bile duct (5.0 vs. 7.7 mm), but had similar biochemical abnormalities and belonged to the same Milwaukee’s classes, mainly class II. None of the patients in the “Opiate group“ were submitted to retrograde cholangiography or endoscopic sphincterotomy vs. 52%and 39%, respectively of the patients of the “Non-Opiate Group“. After a mean follow-up of 3.5 years, there were three recurrences of biliary-type pain (1 choledochal stone, and 2 suspected sphincter of Oddi dysfunction) in the “Opiate Group“, and 2 (1 choledochal stone, 1 after codeine intake) in the “Non-Opiate Group“. Conclusions-Opiate intake is a frequent cause of suspicion of sphincter of Oddi dysfunction after cholecystectomy, especially in young patients with a narrow common bile duct. A careful history taking is essential to avoid unnecessary and potentially harmful procedures.展开更多
文摘随着内镜下,术中或经T管oddi括约肌测压技术出现,人们对oddi括约肌(sphincter of oddi,SO)的生理与病理生理有了深入的了解,Oddi括约肌运动功能障碍(sphincter of oddi dysfunction,SOD)已被大部分学者接受。SOD是由于SO运动障碍或良性狭窄引起的功能失调,但目前很难在组织学水平研究人体SO,故很难将功能性紊乱与器质性改变区分开。SOD的诊断有赖于临床表现、生化测定、激发试验、超声扫描、ERCP、SO测压等多种检查方法,采用单一方法诊断SOD并不可靠。目前SOD到底是解剖上的病变或生理学上的功能障碍尚不明确固治疗SOD的方法多样化,主要药物治疗、内镜治疗、外科手术,但至今,没有一套完善的治疗方法.寻找新的安全、简便、有效的治疗方法,是一项比较艰巨的任务。目前学者探寻肉毒毒素作用于SO,以期能主动调节SO有规律收缩舒张,使其处于一个相对稳定的状态,以维持SO的生理功能。
文摘胆总管末端Oddi括约肌功能状态是普外科临床的一个重要课题,现已引起临床医师们的关注。Oddi括约肌功能障碍（sphincter of oddi dysfunction,SODF）是指Oddi括约肌失去正常生理功能,出现上腹部胆胰源性疼痛、餐后腹胀、肝或胰酶升高、胆总管扩张或胰腺炎发作等一系列临床症状。
文摘Aims-Pain recurrence after cholecystectomy is often attributed to sphincter of Oddi dysfunction, whose diagnostic criteria and treatments remain uncertain. We performed a retrospective study to assess the possible precipitating role of opiate ingestion in this setting. Methods-The retrospective study of the files of 147 consecutive patients investigated for post-cholecystectomy syndrome by endoscopic ultrasonography and/or endoscopic retrograde cholangiography yielded 37 cases of suspected biliary-type sphincter of Oddi dysfunction. Results-Thirteen patients (30%) with suspected sphincter of Oddi dysfunction had taken opiate-containing drugs 15 minutes to two hours (median 1 hr) before the onset of pain (“Opiate group“). When compared with the 23 patients having not taken opiates (“Non Opiate Group“), they were significantly younger (47 vs. 60 yrs), had a narrower common bile duct (5.0 vs. 7.7 mm), but had similar biochemical abnormalities and belonged to the same Milwaukee’s classes, mainly class II. None of the patients in the “Opiate group“ were submitted to retrograde cholangiography or endoscopic sphincterotomy vs. 52%and 39%, respectively of the patients of the “Non-Opiate Group“. After a mean follow-up of 3.5 years, there were three recurrences of biliary-type pain (1 choledochal stone, and 2 suspected sphincter of Oddi dysfunction) in the “Opiate Group“, and 2 (1 choledochal stone, 1 after codeine intake) in the “Non-Opiate Group“. Conclusions-Opiate intake is a frequent cause of suspicion of sphincter of Oddi dysfunction after cholecystectomy, especially in young patients with a narrow common bile duct. A careful history taking is essential to avoid unnecessary and potentially harmful procedures.
