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SO...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。展开更多
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(S...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。展开更多
Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correct...Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correctable sphincter defects leading to an improvement in clinical outcome in these patients.The purpose of this study was to compare these 2 techniques to determine which is more predictive of outcome for fecal incontinence.Thirty-five unselected patients with fecal incontinence were prospectively studied with EUS and anorectal manometry to evaluate the internal anal sphincter(IAS)and external anal sphincter(EAS).EUS was performed with Olympus GFUM20 echoendoscope and a hypoechoic defect in the EAS or IAS was considered a positive test.Anorectal manometry was performed with a standard water-perfused catheter system.A peak voluntary squeeze pressure of < 60 mm Hg in women and 120 mm Hg in men was considered a positive test.All patients were administered the Cleveland Clinic Continence Grading Scale at baseline and at follow-up.Improvement in fecal control was defined as a 25%or greater decrease in continence score.EUS versus manometry were compared with subsequent surgical treatment and outcome.P-values were calculated using Fisher’s exact test.Patients(n = 32;31 females)were followed for a mean 25 months(range 13-46).Sixteen patients had improved symptoms(50%).There was no correlation between EUS or anorectal manometry sphincter findings and outcome.Seven of 14(50%)patients who subsequently underwent surgery versus 9 of 18(50%)without surgery improved(P =.578).In long-term follow-up,approximately half of patients improve regardless of the results of EUS or anorectal manometry,or whether surgery is performed.展开更多
文摘目的评价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。
文摘内镜下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。
文摘Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correctable sphincter defects leading to an improvement in clinical outcome in these patients.The purpose of this study was to compare these 2 techniques to determine which is more predictive of outcome for fecal incontinence.Thirty-five unselected patients with fecal incontinence were prospectively studied with EUS and anorectal manometry to evaluate the internal anal sphincter(IAS)and external anal sphincter(EAS).EUS was performed with Olympus GFUM20 echoendoscope and a hypoechoic defect in the EAS or IAS was considered a positive test.Anorectal manometry was performed with a standard water-perfused catheter system.A peak voluntary squeeze pressure of < 60 mm Hg in women and 120 mm Hg in men was considered a positive test.All patients were administered the Cleveland Clinic Continence Grading Scale at baseline and at follow-up.Improvement in fecal control was defined as a 25%or greater decrease in continence score.EUS versus manometry were compared with subsequent surgical treatment and outcome.P-values were calculated using Fisher’s exact test.Patients(n = 32;31 females)were followed for a mean 25 months(range 13-46).Sixteen patients had improved symptoms(50%).There was no correlation between EUS or anorectal manometry sphincter findings and outcome.Seven of 14(50%)patients who subsequently underwent surgery versus 9 of 18(50%)without surgery improved(P =.578).In long-term follow-up,approximately half of patients improve regardless of the results of EUS or anorectal manometry,or whether surgery is performed.
