目的:探讨胆石症患者十二指肠胆道反流的发生与Oddi括约肌压力之间的关系.方法:采用口服核素观察十二指肠胆道反流的方法,将51例胆道残石患者分为反流组和对照组,并从中随机双盲选择33例患者进行Oddi括约肌测压研究,比较十二指肠胆道反...目的:探讨胆石症患者十二指肠胆道反流的发生与Oddi括约肌压力之间的关系.方法:采用口服核素观察十二指肠胆道反流的方法,将51例胆道残石患者分为反流组和对照组,并从中随机双盲选择33例患者进行Oddi括约肌测压研究,比较十二指肠胆道反流的发生与Oddi括约肌压力之间是否存在一定的关系.结果:51例行胆道取石T型管引流术后的患者中有16例检测到十二指肠胆道反流(31%);所选择的33例患者中有10例检测到十二指肠胆道反流(反流组),余23例未检测到反流的作为对照组,反流组Oddi括约肌基础压、收缩波幅、胆总管压显著低于对照组(7.2±3.9 mmHg vs 14.7±11.0 mmHg,53.5±24.5 mmHg vs 117.2±65.6 mmHg,5.1±1.6 mmHg vs 11.5±7.4 mmHg,P<0.05).两组十二指肠压(DP)、Oddi括约肌收缩频率(SOF)及收缩间期(SOD)无显著性差异(P>0.05).结论:肠胆反流的发生与Oddi括约肌收缩波幅、基础压及胆肠压力差显著性下降有关,而与Oddi括约肌的收缩频率、间期及十二指肠压无关.展开更多
经内镜乳头括约肌切开术（ endoscopic sphincterotomy，EST）是在ERCP诊断性技术的基础上发展起来的，是一种内镜下高频电切开十二指肠乳头及胆总管末端括约肌的治疗技术。EST经过近40年的临床应用和发展，已经成为胆总管结石、胆源性...经内镜乳头括约肌切开术（ endoscopic sphincterotomy，EST）是在ERCP诊断性技术的基础上发展起来的，是一种内镜下高频电切开十二指肠乳头及胆总管末端括约肌的治疗技术。EST经过近40年的临床应用和发展，已经成为胆总管结石、胆源性胰腺炎、急性梗阻性化脓性胆管炎及乳头括约肌功能障碍（sphincter of Oddi dysfunction，SOD）等胆胰疾病的内镜下标准治疗方式。但EST需部分或全部切开胆管或胰管括约肌，势必会带来Oddi括约肌结构和功能的损伤。展开更多
AIM: To assess the diagnostic value of a combination of continuous intragastric pH and bilirubin monitoring in the detection of duodenogastric reflux (DGR), and the effects of diet on the bilirubin absorbance. METHODS...AIM: To assess the diagnostic value of a combination of continuous intragastric pH and bilirubin monitoring in the detection of duodenogastric reflux (DGR), and the effects of diet on the bilirubin absorbance. METHODS: 30 healthy volunteers were divided into two groups: standard diet group (Group 1) 18 cases, free diet group (Group 2)12 cases. Each subjects were subjected to simultaneous 24-hour intragastric pH and spectrophotometric bilirubin concentration monitoring (Bilitec 2000). RESULTS: There was no difference of preprandial phase bilirubin absorbance between two groups. The absorbance of postprandial phase was significantly increased in group 2 than group 1. There was no difference between preprandial phase and postprandial phase absorbance in group 1. Postprandial phase absorbance was significantly higher in group 2. In a comparison of bile reflux with intragastric pH during night time, there were 4 types of reflux: Simultaneous increase in absorbance and pH in only 19.6%, increase in bilirubin with unchanged pH 33.3%, pH increase with unchanged absorbance 36.3%, and both unchanged in 10.8%. Linear regression analysis showed no correlation between percentage total time of pH【4 and percentage total time of absorbance】0.14, r=0.068 P【0.05. CONCLUSION: Because of the dietary effect, high absorbance fluids or foods should be avoided in detection. Intragastric pH and bilirubin monitoring separately predict the presence of duodenal (and/or pancreatic) reflux and bile reflux. They can not substitute for each other. The detection of DGR is improved if the two parameters are combined simultaneously.展开更多
文摘目的:探讨胆石症患者十二指肠胆道反流的发生与Oddi括约肌压力之间的关系.方法:采用口服核素观察十二指肠胆道反流的方法,将51例胆道残石患者分为反流组和对照组,并从中随机双盲选择33例患者进行Oddi括约肌测压研究,比较十二指肠胆道反流的发生与Oddi括约肌压力之间是否存在一定的关系.结果:51例行胆道取石T型管引流术后的患者中有16例检测到十二指肠胆道反流(31%);所选择的33例患者中有10例检测到十二指肠胆道反流(反流组),余23例未检测到反流的作为对照组,反流组Oddi括约肌基础压、收缩波幅、胆总管压显著低于对照组(7.2±3.9 mmHg vs 14.7±11.0 mmHg,53.5±24.5 mmHg vs 117.2±65.6 mmHg,5.1±1.6 mmHg vs 11.5±7.4 mmHg,P<0.05).两组十二指肠压(DP)、Oddi括约肌收缩频率(SOF)及收缩间期(SOD)无显著性差异(P>0.05).结论:肠胆反流的发生与Oddi括约肌收缩波幅、基础压及胆肠压力差显著性下降有关,而与Oddi括约肌的收缩频率、间期及十二指肠压无关.
文摘经内镜乳头括约肌切开术（ endoscopic sphincterotomy，EST）是在ERCP诊断性技术的基础上发展起来的，是一种内镜下高频电切开十二指肠乳头及胆总管末端括约肌的治疗技术。EST经过近40年的临床应用和发展，已经成为胆总管结石、胆源性胰腺炎、急性梗阻性化脓性胆管炎及乳头括约肌功能障碍（sphincter of Oddi dysfunction，SOD）等胆胰疾病的内镜下标准治疗方式。但EST需部分或全部切开胆管或胰管括约肌，势必会带来Oddi括约肌结构和功能的损伤。
基金the Public Health Ministry Foundation of China,No.06-9602-13
文摘AIM: To assess the diagnostic value of a combination of continuous intragastric pH and bilirubin monitoring in the detection of duodenogastric reflux (DGR), and the effects of diet on the bilirubin absorbance. METHODS: 30 healthy volunteers were divided into two groups: standard diet group (Group 1) 18 cases, free diet group (Group 2)12 cases. Each subjects were subjected to simultaneous 24-hour intragastric pH and spectrophotometric bilirubin concentration monitoring (Bilitec 2000). RESULTS: There was no difference of preprandial phase bilirubin absorbance between two groups. The absorbance of postprandial phase was significantly increased in group 2 than group 1. There was no difference between preprandial phase and postprandial phase absorbance in group 1. Postprandial phase absorbance was significantly higher in group 2. In a comparison of bile reflux with intragastric pH during night time, there were 4 types of reflux: Simultaneous increase in absorbance and pH in only 19.6%, increase in bilirubin with unchanged pH 33.3%, pH increase with unchanged absorbance 36.3%, and both unchanged in 10.8%. Linear regression analysis showed no correlation between percentage total time of pH【4 and percentage total time of absorbance】0.14, r=0.068 P【0.05. CONCLUSION: Because of the dietary effect, high absorbance fluids or foods should be avoided in detection. Intragastric pH and bilirubin monitoring separately predict the presence of duodenal (and/or pancreatic) reflux and bile reflux. They can not substitute for each other. The detection of DGR is improved if the two parameters are combined simultaneously.
