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
The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pat...The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pathophysiology,morbidity,mortality and prevention of post-ERCP pancreatitis(PEP) in adult patients using the PubMed database.Search terms included endoscopic retrograde cholangiopancreatography,pancreatitis,ampulla of vater,endoscopic sphincterotomy,balloon dilatation,cholangiography,adverse events,standards and utilization.We limited our review of articles to those published between January 1,1994 and August 15,2009 regarding human adults and written in the English language.Publicat ions from the reference sections were reviewed and included if they were salient and fell into the time period of interest.Between the dates queried,seventeen large(> 500 patients) prospective and four large retrospective trials were conducted.PEP occurred in 1-15 in the prospective trials and in 1-4 in the retrospective trials.PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis.Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last f ifteen years in 63 trials.Although 22 of 63 trials published during our period of review suggested a reduction in PEP,no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP.In conclusion,PEP is a well-recognized complication of ERCP.Medical treatment for prevention has been disappointing.Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials.展开更多
Oddi括约肌(sphincter of Oddi)是机体内一个复杂而精细调节的结构,它是由围绕于胆总管末段、胰管末段及胆胰管汇合Vater壶腹的三部分肌束组成。近年来,随着对Oddi括约肌的解剖结构与生理功能研究的不断深入,人们已认识到Oddi括约肌在...Oddi括约肌(sphincter of Oddi)是机体内一个复杂而精细调节的结构,它是由围绕于胆总管末段、胰管末段及胆胰管汇合Vater壶腹的三部分肌束组成。近年来,随着对Oddi括约肌的解剖结构与生理功能研究的不断深入,人们已认识到Oddi括约肌在维护胆道系统与胰管系统的正常压力、胆汁与胰液的流体力学、胆道与胰管系统的无菌状态以及阻止十二指肠液反流等方面均具有不可替代的关键作用;其结构与功能的受损或被废弃可导致一系列胆胰疾病的发生。因此,当代胆道外科医生应该充分认识到保护Oddi括约肌的重要性。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The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pathophysiology,morbidity,mortality and prevention of post-ERCP pancreatitis(PEP) in adult patients using the PubMed database.Search terms included endoscopic retrograde cholangiopancreatography,pancreatitis,ampulla of vater,endoscopic sphincterotomy,balloon dilatation,cholangiography,adverse events,standards and utilization.We limited our review of articles to those published between January 1,1994 and August 15,2009 regarding human adults and written in the English language.Publicat ions from the reference sections were reviewed and included if they were salient and fell into the time period of interest.Between the dates queried,seventeen large(> 500 patients) prospective and four large retrospective trials were conducted.PEP occurred in 1-15 in the prospective trials and in 1-4 in the retrospective trials.PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis.Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last f ifteen years in 63 trials.Although 22 of 63 trials published during our period of review suggested a reduction in PEP,no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP.In conclusion,PEP is a well-recognized complication of ERCP.Medical treatment for prevention has been disappointing.Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials.
文摘Oddi括约肌(sphincter of Oddi)是机体内一个复杂而精细调节的结构,它是由围绕于胆总管末段、胰管末段及胆胰管汇合Vater壶腹的三部分肌束组成。近年来,随着对Oddi括约肌的解剖结构与生理功能研究的不断深入,人们已认识到Oddi括约肌在维护胆道系统与胰管系统的正常压力、胆汁与胰液的流体力学、胆道与胰管系统的无菌状态以及阻止十二指肠液反流等方面均具有不可替代的关键作用;其结构与功能的受损或被废弃可导致一系列胆胰疾病的发生。因此,当代胆道外科医生应该充分认识到保护Oddi括约肌的重要性。