Oddi括约肌与胆管色素结石形成关系的探讨  

The relationship between Oddi's sphincter and bile duct pigment gallstone

作　　者：吴硕东[1] 于宏[1] 王昊霖[1] 苏洋[1] 张振海[1] 孙韶龙[1] 孔静[1] 田雨[1] 田忠[1] 魏义[1] 金红旭[1] 金俊哲[1] 

机构地区：[1]中国医科大学附属第二医院外二科,沈阳100004

出　　处：《中华外科杂志》2007年第1期58-61,共4页Chinese Journal of Surgery

摘　　要：目的探讨 Oddi 括约肌结构及功能异常与胆管色素结石形成之间的关系。方法胆道术后留有 T 型管的患者123例,使用放射性核素^(99m)Tc-DTPA 判断是否存在肠胆反流,以此将患者分为反流组及非反流组,检测空腹血胃动素、胃泌素水平,随机选取53例使用胆道镜测压。采用钡餐透视观察胆管色素结石、非胃肠胆道疾病、胆囊息肉、胆囊胆固醇结石患者的十二指肠降段憩室发生率;十二指肠镜观察原发性胆管色素结石、胆管结石合并胆囊结石、继发于胆囊结石的胆管结石、胆管末端和乳头部炎症狭窄、胆管末端癌和乳头癌、胆囊切除术后综合征患者的十二指肠憩室内(旁)乳头的发生率。结果123例行胆道取石 T 型管引流术后的患者中有44例检测到十二指肠胆道反流(35.8%),反流组 Oddi 括约肌基础压(SOBP)、收缩波幅(SOCA)、胆总管压(CBDP)显著低于对照组(P<0.01)。反流组血胃动素、胃泌素水平明显低于无反流组及对照组(P<0.01)。血胃动素与SOBP、血胃泌素与 SOBP 及 CBDP 呈正相关。钡餐摄影显示胆总管色素结石患者十二指肠降段憩室发生率达36.62%,明显高于其他3组(P<0.05)。胆管胆色素结石患者十二指肠憩室内(旁)乳头的发生率明显高于继发于胆囊结石的胆管结石组、胆管末端和乳头部炎症狭窄组及胆管末端癌和乳头癌组(P<0.05)。结论胆管色素结石患者存在明显的肠胆反流和胆系感染,Oddi 括约肌结构与功能状态与胆管色素结石形成密切相关,其解剖及功能异常是胆管色素结石形成的重要原因。Objective To investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of bile duct pigment gallstone. Methods One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of ^99mTc-DTPA in the bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal pressure of Oddi＇s sphincter（ SOBP）. amplitude of Oddi＇ s sphincter （ SOCA ）. frequency of contraction （ SOF）. duration of contraction （ SOD ）. duodenal pressure（DP） .common bile duct pressure（CBDP） were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with bile duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampunary diverticulum in patients with primary bile duct pigment stones, patients with bile duct stone and gallbladder stones, patients with bile duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope. Results Of the patients, 44 were detected with duedenal-biliary reflux（35. 8% ）. SOBP, SOCA and CBDP in the reflux group were much lower than those in control group （ P 〈 0. 001 ）. The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group（ P 〈0. 01 ）. Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in

关 键 词：胆结石 奥狄氏括约肌 肠胆反流 

分 类 号：R657.42[医药卫生—外科学]