Oddi括约肌测压术在慢性胆胰疾病诊治中的应用价值

目的评价Oddi括约肌测压术（sphincter of Oddi manometry,SOM）在慢性胆胰疾病诊治中的应用价值。方法回顾分析我院2005年5月-2009年1月11例慢性上腹痛疑似Oddi括约肌功能紊乱（sphincter of Oddi dysfunction,SOD）在ERCP检查时接受SOM的临床资料,分析测压结果、ERCP诊治情况,并随访远期疗效。结果SOM结果正常2例（18.2%）,均为胆囊切除术后腹痛待查患者,未行乳头括约肌切开术（endoscopic sphincterotomy,EST）,长期随访腹痛无加重,未再因此就医。5例复发性胰腺炎和4例腹痛伴胆总管增宽的SOM均存在不同程度的异常：Oddi括约肌基础压力为（52.7±19.2）mm Hg（34-96.5mm Hg）;蠕动压力为（167.3±24.8）mm Hg（140-200mm Hg）。9例SOM结果异常者均接受EST治疗,术后随访7例（77.8%）获得良好效果,2例复发性胰腺炎再次行ERCP并放置胰管支架后获满意疗效。结论SOM有助于评价Oddi括约肌功能,尤其适用于胆囊切除术后腹痛怀疑为SODⅢ型的患者,可以帮助明确诊断SOD,指导ERCP治疗。

Oddi括约肌测压及内镜下十二指肠乳头切开术对Oddi括约肌运动功能障碍诊治的意义

本文对60例胆囊切除术后复发腹痛患者进行0ddi括约肌测压研究,并探讨内镜下十二指肠乳头切开术(EPT)对Oddi括约肌基础压升高患者疗效。用低顺应性水灌注系统,三通道测压导管,观察Oddi括约肌基翻压、Oddi括约肌基础收缩幅度、频率和传播方式。对Oddi括约肌基础压>35mmHg者,随机分为两组,一组予以EPT治疗,另一组做为对照,并随访其疗效。结果发现:Oddi括约肌测压异常发生率为46.7％。Oddi括约肌基础压升高者,EPT治疗后,随访3～18月,有效率为91.7％,明显高于对照组(P<0.05)。结论:Oddi括约肌测压对Oddi括约肌运动功能障碍(SOD)的诊断具有较高价值。测压发现Oddi括约肌基础压升高患者EPT可获得满意的长期疗效。

Oddi括约肌测压

内镜下Oddi括约肌测压可直接对Oddi括约肌(sphincter of oddi,SO)运动功能进行评价,被认为是Oddi括约肌功能障碍(sphincter of oddi dysfunction,SOD)诊断的金标准,对Oddi括约肌功能障碍的治疗及预后判断具有很大意义。Oddi括约肌测压(Sphincter of oddi manometry,SOM)是一项有创性的操作,对操作人员要求严格,术后胰腺炎发生风险高,临床应用受到一定限制。目前一些研究主要致力于通过改善导管构造、类型,明确SOM适应证,谨慎选择患者来减少SOM术后相关胰腺炎的发生率。本文就Oddi括约肌测压的技术方法,有效性、安全性、数据结果的准确性、测压术后合并症,以及其在胆胰疾病诊治中的应用作一综述。

奥狄括约肌测压的演进过程及意义

奥狄括约肌测压是诊断奥狄括约肌功能障碍的金标准。但由于奥狄括约肌生理解剖位置的特殊性,人们对其研究仍有一定局限性。本文旨在综述奥狄括约肌和胆胰管测压技术发展演进过程、各种导管的特点及测压相关并发症等。

吗啡、山莨菪碱及硫酸镁对Oddi括约肌压力的影响

目的经胆道镜行Oddi括约肌(SO)测压,观察常规剂量吗啡对SO的作用,以及常规剂量山莨菪碱、硫酸镁对吗啡的拮抗作用。方法胆道术后留有T管的病人共30例,随机分为对照组、山莨菪碱组、硫酸镁组,测定用药前后的SO基础压、收缩波幅、收缩频率、收缩间期及胆总管压。结果肌注吗啡后SO基础压、收缩幅度和胆总管压力均明显升高,SO收缩频率明显增快;肌注15mg山莨菪碱,SO基础压和收缩幅度明显下降;口服25%硫酸镁10g,SO收缩幅度明显下降。结论常规剂量的吗啡,可提高胆总管压、SO基础压、收缩波幅及收缩频率;山莨菪碱、硫酸镁可以拮抗吗啡对SO的激动作用。

家兔急性胰腺炎模型Oddi括约肌功能的变化及意义

目的:研究家兔急性胰腺炎时Oddi括约肌运动功能的变化规律,探讨Oddi括约肌功能紊乱在急性胰腺炎病理演进中的作用。方法:建立家兔急性胰腺炎模型,用Oddi括约肌测压法研究Oddi括约肌功能动态变化。结果:实验组Oddi括约肌基础压、收缩频率于急性胰腺炎前、后各时相有显著差异(P<0. 01),与对照组差异显著(P<0. 05)。蠕动波振幅无明显改变(P>0. 05)。结论:家兔急性胰腺炎Oddi括约肌运动功能早期表现Oddi括约肌痉挛, 3h达峰值,而后期则为Oddi括约肌迟缓。Oddi括约肌功能紊乱不仅是急性胰腺炎的病因之一,也是急性胰腺炎产生的一种病理生理改变,可加重胰腺炎病情。

硬化剂注射疗法治疗内痔对肛管内压力的影响

本文报告了22例内痔出血患者采用肛门镜下硬化剂注射治疗前后肛管括约肌压力变化,探讨内痔硬化剂注射治疗后对肛管括约肌生理功能的影响。结果表明肛管压在注射硬化剂治疗后肛管括约肌的静息压和收缩压均明显下降,与治疗前相比距肛缘1cm、3cm处肛管静息压P值分别为<0.007及<0.001,肛管收缩压P值<0.05,近期止血率达100％。我们认为采用肛门镜下硬化剂注射治疗具有方法简便,安全有效,可反复注射治疗,无并发症等优点,并可明显降低肛管内静息压和收缩压,减少内痔复发。

白芍对膀胱引流式犬胰腺移植Oddi括约肌功能的影响

目的:研究白芍对膀胱引流式犬胰腺移植后移植物Oddi括约肌(SO)功能的影响。方法:正常犬和膀胱引流式胰腺移植后犬应用白芍前后进行SO测压。结果:白芍对正常犬SO收缩幅度无影响(P>0.05),但可降低SO的基础压、收缩频率和动力指数(P<0.01)。移植后应用白芍可全面降低SO基础压、收缩频率、收缩幅度和动力指数(P<0.01)。结论:白芍可抑制犬SO运动,胰腺移植后,抑制作用更加显著,有助于防治移植物胰腺炎。

Choledochoscope manometry about different drugs on the Sphincter of Oddi

AIM： To assess the effects of H2-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents on the human Sphincter of Oddi （SO） motility by choledochoscope manometry. METHODS： One hundred and seventy-five patients with T tube installed after cholecystectomy and choledochotomy were assessed by choledochoscope manometry. They were randomly assigned into groups of H2-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents. The Sphincter of Oddi basal pressure （SOBP）, amplitude （SOCA）, frequency of contractions （SOF）, duodenal pressure （DP）, and common bile duct pressure （CBDP） were scored and analyzed. RESULTS： SOBP and SOCA were significantly decreased after Cimetidine administration, and no statistical difference was seen in the Famotidine group. In the Gabexate mesilate group, SOBP had decreased significantly. In the Ulinastatin group, SOCA decreased when Ulinastatin was given at the rate of 2500 U/min; when Ulinastatin administration was raised to 5000 U/ rain, SOBP, SOF and SOCA all experienced a fall. SOBP and SOCA for Domperidone and SOCA for Mosapride groups all decreased distinctly after administration. CONCLUSION： The regular dosage of Cimetidine showed an inhibitory effect on the motility of SO, while Famotidine had no obvious effects otherwise. Gabnexata mesilate, Ulinastatin and gastro kinetic agents also showed inhibitory effects on the SO motility.

Sphincter of Oddi dysfunction:Psychosocial distress correlates with manometric dyskinesia but not stenosis

AIM:To compare postcholecystectomy patients with Sphincter of Oddi(SO)dyskinesia and those with normal SO motility to determine the psychosocial distress,gender and objective clinical correlates of dyskinesia,and contrast these findings with comparisons between SO stenosis and normal SO motility.METHODS:Within a cohort of seventy-two consecutive postcholecystectomy patients with suspected SO dysfunction,manometric assessment identified subgroups with SO dyskinesia(n=33),SO stenosis(n=18)and normal SO motility(n=21).Each patient was categorized in terms of Milwaukee Type,sociodemographic status and the severity of stress-coping experiences.RESULTS:Logistic regression revealed that in combination certain psychological,sociodemographic and clinical variables significantly differentiated SO dyskinesia,but not SO stenosis,from normal SO function.Levels of psychosocial stress and of coping with this stress(i.e.anger suppressed more frequently and the use of significantly more psychological coping strategies)were highest among patients with SO dyskinesia,especially women.Higher levels of neuroticism(the tendency to stressproneness)further increased the likelihood of SO dyskinesia.CONCLUSION:A motility disturbance related to psychosocial distress may help to explain the finding of SO dyskinesia in some postcholecystectomy patients.

犬Oddi括约肌狭窄模型的建立及其胆道动力学的变化

目的建立犬Oddi括约肌（sphincter of Oddi,SO）狭窄模型,探讨其胆道动力学的变化。方法禁食16～18h成年杂种犬麻醉后,超声测量胆总管管径。实验组行经腹切开十二指肠,机械性损伤SO致其狭窄;对照组仅行经腹切开十二指肠,术毕饲养。定期检查肝功能,4周后再次麻醉下行超声测量胆总管管径及开腹行SO测压。最后切取SO及周围组织行病理检查。结果实验组术后4周肝功能TBIL、DBIL、GGT、ALP明显高于术前,超声测量胆总管管径大于术前,病理检查发现括约肌组织纤维化,而对照组均无明显变化。与对照组相比,实验组胆总管及SO基础压明显升高,SO收缩幅度降低,收缩频率升高,收缩时间缩短。结论SO狭窄模型成功建立;Oddi括约肌狭窄后其胆道动力学发生明显改变。

内镜技术预防ERCP术后胰腺炎

内镜下逆行胰胆管造影（endoscopic retrograde cholangiopancreatography, ERCP）术后胰腺炎（post-ERCP pancreatitis，PEP）是ERCP最常见的并发症，发生率为3.5%，其中90%为轻、中度，但仍然有严重病例导致死亡。PEP的发生机制尚未完全明确，一般认为多因素参与，包括机械性损伤（乳头插管、胰管导丝置入、乳头括约肌切开等）、化学性损伤（胰管造影）、静水压力性损伤（灌注式Oddi括约肌测压）和感染。其中，几乎每个方面均与ERCP操作技术相关。

Quantitative evaluation of the anal sphincter by the tendency presented in the manometric asymmetry variations

OBJECTIVES: To assess the tendency of manometric asymmetry, and to quantitatively evaluate the function of the anal sphincter. METHODS: Using the PC polygram HR at the states of relax and squeeze, we compared the values of pressure asymmetry in the anorectum of 27 normal children with that of 12 children with fecal incontinence. RESULTS: In the two states, the anal sphincter in normal children showed not only the gradient of pressure, but also a gradient of pressure asymmetry. Children with fecal incontinence did not show any gradients. CONCLUSION: Gradients of pressure and pressure asymmetry can quantitatively evaluate the function of the anal sphincter.