目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制。材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周...目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制。材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周后十二指肠压(duodenal pressure,DP)、SO基础压(sphincter of Oddi basal pressure,SOBP)、收缩幅度(sphincter of Oddi contractive amplitude,SOCA)、收缩间期(sphincter of Oddi duration,SOD)以及胆总管压(common bile duct pressure,CBDP)的变化。同时,应用胶原纤维染色观察支架置入后SO的病理变化。对实验所获得的计量资料采用配对t检验进行比较,P<0.05为差异有统计学意义。结果:以DP作为零点,获得其他各项指标的相对值结果。支架置入前SOBP、SOCA、SOD、CBDP分别为:13.69±4.29mmHg、42.65±8.50mmHg、6.69±1.46s、12.98±2.86mmHg;支架置入5周后分别为:10.58±3.98mmHg、31.95±9.00mmHg、4.47±1.21s、7.43±2.20mmHg,其中SOCA较支架置入前降低,SOD相比支架置入前缩短,两者的差异均有统计学意义(P<0.05)。而CBDP明显低于支架置入前,差异具有统计学意义(P<0.05)。支架置入5周后,壶腹部SO肌层中发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。结论:跨越壶腹部植入支架5周后,SO运动功能的减弱以紧张性收缩的减弱为主,而基础性收缩仍然存在。CBDP虽然下降,但仍高于正常的DP,并保持与之的压力梯度,从而为抑制肠胆反流提供了可能。而壶腹部SO肌层中则发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。展开更多
Our purpose was to determine if the presence of duodenal diverticula predispo ses to the development of pancreaticobiliary disease. Between May 1999 and Febru ary 2001, 381 patients were examined by endoscopic retrogr...Our purpose was to determine if the presence of duodenal diverticula predispo ses to the development of pancreaticobiliary disease. Between May 1999 and Febru ary 2001, 381 patients were examined by endoscopic retrograde cholangiopancreati cography. Of these patients, 51 had periampullary diverticula. In 27 patients th e papilla was located inside the diverticulum (Group I), in 19 patients it was l ocated at the edge of the diverticulum (Group II), and 5 patients it was located at a distance closer than 3 cm to the diverticulum (Group III). Seventeen patie nts in group I and 11 patients in group II had had a previous cholecystectomy. T he overall incidence of biliary system stone disease was 22.2% in group I, 36. 8% in group II, and 100% in group III. All patients were treated with endosc opic sphincterotomy and three (two in group I and one in group II) developed bil iary system disease (cholangitis or pancreatitis). We think that sphincterotomy should be applied regardless of the presence of stone if the papilla is located inside or at the edge of the diverticulum. If the papilla is located 3 cm or mor e far for diverticulum , it should be considered within the frame of general sph incterotomy indications in the absence of stone disease.展开更多
文摘目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制。材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周后十二指肠压(duodenal pressure,DP)、SO基础压(sphincter of Oddi basal pressure,SOBP)、收缩幅度(sphincter of Oddi contractive amplitude,SOCA)、收缩间期(sphincter of Oddi duration,SOD)以及胆总管压(common bile duct pressure,CBDP)的变化。同时,应用胶原纤维染色观察支架置入后SO的病理变化。对实验所获得的计量资料采用配对t检验进行比较,P<0.05为差异有统计学意义。结果:以DP作为零点,获得其他各项指标的相对值结果。支架置入前SOBP、SOCA、SOD、CBDP分别为:13.69±4.29mmHg、42.65±8.50mmHg、6.69±1.46s、12.98±2.86mmHg;支架置入5周后分别为:10.58±3.98mmHg、31.95±9.00mmHg、4.47±1.21s、7.43±2.20mmHg,其中SOCA较支架置入前降低,SOD相比支架置入前缩短,两者的差异均有统计学意义(P<0.05)。而CBDP明显低于支架置入前,差异具有统计学意义(P<0.05)。支架置入5周后,壶腹部SO肌层中发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。结论:跨越壶腹部植入支架5周后,SO运动功能的减弱以紧张性收缩的减弱为主,而基础性收缩仍然存在。CBDP虽然下降,但仍高于正常的DP,并保持与之的压力梯度,从而为抑制肠胆反流提供了可能。而壶腹部SO肌层中则发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。
文摘Our purpose was to determine if the presence of duodenal diverticula predispo ses to the development of pancreaticobiliary disease. Between May 1999 and Febru ary 2001, 381 patients were examined by endoscopic retrograde cholangiopancreati cography. Of these patients, 51 had periampullary diverticula. In 27 patients th e papilla was located inside the diverticulum (Group I), in 19 patients it was l ocated at the edge of the diverticulum (Group II), and 5 patients it was located at a distance closer than 3 cm to the diverticulum (Group III). Seventeen patie nts in group I and 11 patients in group II had had a previous cholecystectomy. T he overall incidence of biliary system stone disease was 22.2% in group I, 36. 8% in group II, and 100% in group III. All patients were treated with endosc opic sphincterotomy and three (two in group I and one in group II) developed bil iary system disease (cholangitis or pancreatitis). We think that sphincterotomy should be applied regardless of the presence of stone if the papilla is located inside or at the edge of the diverticulum. If the papilla is located 3 cm or mor e far for diverticulum , it should be considered within the frame of general sph incterotomy indications in the absence of stone disease.
