胆管结石患者术后经“T”管窦道胆道镜Oddi括约肌测压的表现及意义  

Choledochoscopic manometry research of the sphincter of Oddi motility in bile duct stone patients with a T tube after operation

作　　者：田忠[1] 吴硕东[2] 孔静[2] 张振海[2] 

机构地区：[1]中国医科大学附属第二医院(盛京医院)第二微创胆道外科,辽宁省沈阳市110003 [2]中国医科大学附属第二医院(盛京医院)第一微创胆道外科,辽宁省沈阳市110003

出　　处：《世界华人消化杂志》2006年第11期1119-1123,共5页World Chinese Journal of Digestology

摘　　要：目的:对胆管结石患者术后经“T”管窦道行胆道镜测压,研究胆管结石患者术后Oddi括约肌(SO)功能,探讨结石与SO功能变化的关系．方法:共对216例患者测量十二指肠压、Oddi 括约肌基础压、收缩幅度、收缩频率、收缩间期、胆总管压以及顺蠕动、逆蠕动及同时收缩所占百分比．对患者根据SO基础压分为4 组:A组(SO运动功能不足组)、B组(SO压力正常组)、C组(SO压力略升高组)和D组(SO功能障碍组),比较各组各测压指标之间差别．结果:A组SO收缩幅度均值为62．32± 32．13 mmHg,较其他三组明显降低(P<0．01); SO收缩间期较B,C组明显缩短(P<0．01);收缩频率与B,C组的差异无统计学意义,但明显小于D组(P<0．05);胆总管压均值为3．89± 8．10 mmHg,较B,C组差异无统计学意义,但是明显低于D组(P<0．01),而且大于SO基础压． D组SO收缩幅度均值为97．02±51．76 mmHg, 与B,C组差异虽无统计学意义,但呈升高趋势,而且明显高于A组(P<0．01);SO收缩间期较C组短(P<0．05),与另外两组差异无统计学意义;SO收缩频率较前三组则明显增快 (P<0．01vsA,B组,P<0．05vsC组);胆总管压均值为10．41±12．37 mmHg,较A,B组明显升高(P<0．01),与C组差别无统计学意义;逆蠕动所占百分比与A,B组相比明显增加(35．73％± 26．38％vs20.31％±21．96％,22．71％±23．86％, P<0．05),与C组差别无统计学意义．结论:胆管结石患者术后存在SO功能障碍及 SO运动功能不足两种病理状况,而且SO的这些异常改变可能与胆管结石的形成和／或复发有关．经T型管窦道胆道镜测压可以作为诊断 SO功能障碍及SO运动功能不足的有效手段．AIM： To study the sphincter of Oddi （SO） motility by choledochoscopic manometry, and to investigate the manometric appearance of sphincter of Oddi disorders and its relationship with bile duct stones. METHODS： Two hundred and sixteet patients who had a T tube after operation were assessed by choledochoscopic manometry. SO basal pressure （SOBP）, amplitude of SO contractions （SOCA）, frequency of SO contractions （SOCF）, duration of SO contractions （SOCD）, duodenal pressure （DP）, common bile duct pressure （CBDP）, and the percentage of propagate directions were scored and analyzed. The patients were divided into 4 groups according to the levels of sphincter of Oddi basal pressure： group A （sphincter of Oddi hypomotility）, group B （normal SOPB）, group C （SOBP a little higher than normal） and group D （sphincter of Oddi dysfunction）. RESULTS： The mean SOCA in group A was 62.32 ± 32.13 mmHg, much lower than that in the other three groups （P 〈 0.01）; the mean SOCD in group A was shorter than that in group B and group C （P 〈 0.01）; the mean SOCF in group A had no significant difference from that in group B and group C, but lower than that in group D （P 〈 0.05）; the mean CBDP in group A was 3.89 ± 8.10 mmHg, much lower than that in group D （P 〈 0.01）, but higher than SOBP. The SOCA in group D was 97.02 ± 51.76 mmHg, apparently higher than that in group A （P 〈 0.01）, which was not significantly different from that in group B and group C, but with a tendency to increase; the mean SOCD in group D was shorter than that in group C （P 〈 0.05）, and there was no apparent difference between the other two groups; the mean SOCF in group D was markedly higher than that in the other three groups （P 〈 0.01 or P 〈 0.05）; the mean CBDP in group D was 10.41 ± 12.37 mmHg, higher than that in group A and B （P 〈 0.01） , but was not statistically different from that in group C; the percentage of retrograde peristalsis in group D （35.73%

关 键 词：ODDI括约肌 功能障碍 运动功能不足 胆道镜 测压 

分 类 号：R657.4[医药卫生—外科学] R657.42[医药卫生—临床医学]