目的 探讨袖套式Oddi括约肌压力测定法（Sleeve type Oddi sphincter pressure measurement,SOM）在Oddi括约肌功能紊乱诊疗中的作用。方法 纳入拟诊为Oddi括约肌功能紊乱患者共26例及对照组患者2例,进行SOM,测定项目包括SO基础压、收...目的 探讨袖套式Oddi括约肌压力测定法（Sleeve type Oddi sphincter pressure measurement,SOM）在Oddi括约肌功能紊乱诊疗中的作用。方法 纳入拟诊为Oddi括约肌功能紊乱患者共26例及对照组患者2例,进行SOM,测定项目包括SO基础压、收缩压、收缩振幅及收缩频率。术后监测各时间点患者的疼痛评分、血清淀粉酶的变化,及术后24 h检查上腹部CT。结果 全部患者均耐受操作,平均操作时间（16.5±0.4）min,与传统的压力检测结果比较,所有患者两次检测的SO基础压、收缩压、收缩振幅及收缩频率差异均无统计学意义（P〉0.05）,其中基础压基本一致。术后1例患者出现轻型胰腺炎,其余27例患者术后48 h内疼痛评分为0~2分,血清淀粉酶及上腹部CT均正常。全部患者未出现其他并发症发生。结论 新型SOM法操作简单,结果可靠,监测时间可控,术后并发症少,并可进行胰管括约肌检测,适合在临床开展。此方法可取代传统灌注式多极压力测定法,用于Oddi括约肌功能紊乱的诊断。展开更多
目的针对反复右上腹痛的患者进行Oddi括约肌测压,以评价Oddi括约肌测压术(SOM)在慢性胆胰疾病诊治中的应用价值,并探讨内镜下十二指肠乳头切开术(EST)对Oddi括约肌基础压升高患者的疗效。方法回顾分析该院2012年10月-2014年9月30例慢性...目的针对反复右上腹痛的患者进行Oddi括约肌测压,以评价Oddi括约肌测压术(SOM)在慢性胆胰疾病诊治中的应用价值,并探讨内镜下十二指肠乳头切开术(EST)对Oddi括约肌基础压升高患者的疗效。方法回顾分析该院2012年10月-2014年9月30例慢性上腹痛疑似Oddi括约肌功能紊乱(SOD)的患者在内镜逆行胰胆管造影术(ERCP)检查时接受SOM的临床资料,观察Oddi括约肌基础压、收缩幅度、频率和传播方式。对Oddi括约肌基础压>40.0 mm Hg者及>30.0 mm Hg并存在血淀粉酶、脂肪酶、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(AKP)升高超过正常值2倍以上和(或)胆总管、胰管管增宽者行EST治疗,并随访其疗效。结果 30例患者SOM均存在不同程度的异常,Oddi括约肌基础压力为(36.6±21.1)mm Hg,收缩幅度为(210.6±25.7)mm Hg,收缩频率为(10.1±3.1)次/min,逆向收缩率为(55.0±8.0)%。30例患者均接受EST治疗,术后随访,其中27例(90.0%)有效。结论 SOM助于评价Oddi括约肌功能,对诊断SOD具有较大价值,测压发现Oddi括约肌基础压升高患者EST治疗可获得满意疗效。展开更多
Background: Serum amylase levels 2 hours after ERCP predict postprocedure pancreatitis. The value of serum amylase measurements after sphincter of Oddi manometry (SOM) and the effect of pancreatic-duct stent placement...Background: Serum amylase levels 2 hours after ERCP predict postprocedure pancreatitis. The value of serum amylase measurements after sphincter of Oddi manometry (SOM) and the effect of pancreatic-duct stent placement on serum amylase are unknown. Methods: Records were reviewed for 88 SOM patients who had serum amylase measured 2 hours after the procedure. Post-SOM pancreatitis was defined as pain with a >3-fold elevation of serum amylase on the morning after SOM. “ Possible pancreatitis" was defined as pain with a < 3- fold elevation of serum amylase on the morning after SOM. Results: Post-SOM pancreatitis and possible pancreatitis each occurred in 13% of the study cohort. Post-SOM pancreatitis was associated with the absence of a pancreatic stent and occurred in 0% of patients without a stent who had normal 2-hour serum amylase vs. 67% with elevated 2-hour serum amylase (p < 0.01). Among patients who received a stent, pancreatitis occurred in 6% , regardless of whether the 2-hour serum amylase was elevated. Possible pancreatitis occurred mainly in patients who received stents, and it also was associated with elevation of the 2-hour serum amylase. Conclusions: Elevation of the serum amylase level 2 hours after SOM predicts post-SOM pancreatitis but only in patients who do not receive a pancreatic stent. Among patients who received a stent, elevated 2-hour serum amylase levels predict subsequent findings that may be caused by attenuated pancreatitis.展开更多
Objective. Although acute pancreatitis is the most significant complication o f sphincter of Oddi manometry (SOM), acute biliary- like abdominal pain - sim ilar or identical to the patient’ s usual recurrent acute ep...Objective. Although acute pancreatitis is the most significant complication o f sphincter of Oddi manometry (SOM), acute biliary- like abdominal pain - sim ilar or identical to the patient’ s usual recurrent acute episodes of pain and not fulfilling clinical criteria for acute pancreatitis - can also be provoked by SOM. The aim of the article is to determine and compare the relative frequen cy of occurrence of, and risk factors for, postmanometry biliary- like abdomina l pain and post- manometry pancreatitis. Material and methods. The clinical and laboratory features, the manometric recordings from the sphincter of Oddi, and the immediate post- manometry outcomes, were examined in 234 consecutive patien ts undergoing sphincter of Oddi manometry at our Unit. Results. Post- manometry pancreatitis occurred in 9% of patients, and was associated with two risk fac tors on multivariate analysis: a history of post- ERCP pancreatitis (odds ratio [OR] 5.9) and a raised basal sphincter pressure (≥ 40 mmHg) at SOM (OR 3.5). A n increased sphincter phasic wave frequency (≥ 7/ min) at SOM was identified as a significant (p < 0.05) risk factor on univariate testing only. Post- manomet ry biliary- like pain occurred in 12% of patients, and was associated with 3 different risk factors on multivariate analysis: age below 50 years (OR 4.6); le ss than a 2- year history of recurrent abdominal pain (OR 3.0); and ERCP and/or ES carried out during the SOM procedure (OR 9.3). Conclusions. Provocation of b iliary- like pain following SOM, without clinical evidence of pancreatitis, occ urs at least as frequently as post- manometry acute pancreatitis. In contrast t o post- manometry pancreatitis, post- manometry biliary- like pain occurs mor e often in younger patients with a shorter duration of symptoms and does not app ear related to the manometric features of the sphincter documented at SOM; we pr opose that this clinical entity may reflect the presence of bile duct or duodena l hypersensitivity/ hyperalgesia.展开更多
文摘目的针对反复右上腹痛的患者进行Oddi括约肌测压,以评价Oddi括约肌测压术(SOM)在慢性胆胰疾病诊治中的应用价值,并探讨内镜下十二指肠乳头切开术(EST)对Oddi括约肌基础压升高患者的疗效。方法回顾分析该院2012年10月-2014年9月30例慢性上腹痛疑似Oddi括约肌功能紊乱(SOD)的患者在内镜逆行胰胆管造影术(ERCP)检查时接受SOM的临床资料,观察Oddi括约肌基础压、收缩幅度、频率和传播方式。对Oddi括约肌基础压>40.0 mm Hg者及>30.0 mm Hg并存在血淀粉酶、脂肪酶、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(AKP)升高超过正常值2倍以上和(或)胆总管、胰管管增宽者行EST治疗,并随访其疗效。结果 30例患者SOM均存在不同程度的异常,Oddi括约肌基础压力为(36.6±21.1)mm Hg,收缩幅度为(210.6±25.7)mm Hg,收缩频率为(10.1±3.1)次/min,逆向收缩率为(55.0±8.0)%。30例患者均接受EST治疗,术后随访,其中27例(90.0%)有效。结论 SOM助于评价Oddi括约肌功能,对诊断SOD具有较大价值,测压发现Oddi括约肌基础压升高患者EST治疗可获得满意疗效。
文摘Background: Serum amylase levels 2 hours after ERCP predict postprocedure pancreatitis. The value of serum amylase measurements after sphincter of Oddi manometry (SOM) and the effect of pancreatic-duct stent placement on serum amylase are unknown. Methods: Records were reviewed for 88 SOM patients who had serum amylase measured 2 hours after the procedure. Post-SOM pancreatitis was defined as pain with a >3-fold elevation of serum amylase on the morning after SOM. “ Possible pancreatitis" was defined as pain with a < 3- fold elevation of serum amylase on the morning after SOM. Results: Post-SOM pancreatitis and possible pancreatitis each occurred in 13% of the study cohort. Post-SOM pancreatitis was associated with the absence of a pancreatic stent and occurred in 0% of patients without a stent who had normal 2-hour serum amylase vs. 67% with elevated 2-hour serum amylase (p < 0.01). Among patients who received a stent, pancreatitis occurred in 6% , regardless of whether the 2-hour serum amylase was elevated. Possible pancreatitis occurred mainly in patients who received stents, and it also was associated with elevation of the 2-hour serum amylase. Conclusions: Elevation of the serum amylase level 2 hours after SOM predicts post-SOM pancreatitis but only in patients who do not receive a pancreatic stent. Among patients who received a stent, elevated 2-hour serum amylase levels predict subsequent findings that may be caused by attenuated pancreatitis.
文摘Objective. Although acute pancreatitis is the most significant complication o f sphincter of Oddi manometry (SOM), acute biliary- like abdominal pain - sim ilar or identical to the patient’ s usual recurrent acute episodes of pain and not fulfilling clinical criteria for acute pancreatitis - can also be provoked by SOM. The aim of the article is to determine and compare the relative frequen cy of occurrence of, and risk factors for, postmanometry biliary- like abdomina l pain and post- manometry pancreatitis. Material and methods. The clinical and laboratory features, the manometric recordings from the sphincter of Oddi, and the immediate post- manometry outcomes, were examined in 234 consecutive patien ts undergoing sphincter of Oddi manometry at our Unit. Results. Post- manometry pancreatitis occurred in 9% of patients, and was associated with two risk fac tors on multivariate analysis: a history of post- ERCP pancreatitis (odds ratio [OR] 5.9) and a raised basal sphincter pressure (≥ 40 mmHg) at SOM (OR 3.5). A n increased sphincter phasic wave frequency (≥ 7/ min) at SOM was identified as a significant (p < 0.05) risk factor on univariate testing only. Post- manomet ry biliary- like pain occurred in 12% of patients, and was associated with 3 different risk factors on multivariate analysis: age below 50 years (OR 4.6); le ss than a 2- year history of recurrent abdominal pain (OR 3.0); and ERCP and/or ES carried out during the SOM procedure (OR 9.3). Conclusions. Provocation of b iliary- like pain following SOM, without clinical evidence of pancreatitis, occ urs at least as frequently as post- manometry acute pancreatitis. In contrast t o post- manometry pancreatitis, post- manometry biliary- like pain occurs mor e often in younger patients with a shorter duration of symptoms and does not app ear related to the manometric features of the sphincter documented at SOM; we pr opose that this clinical entity may reflect the presence of bile duct or duodena l hypersensitivity/ hyperalgesia.
