肠胆反流与Oddi括约肌压力之间的关系  

Relationship between duodenobiliary reflux and pressure of Oddi sphincter

作　　者：孙韶龙[1] 崔东旭[1] 戴显伟[1] 吴硕东[1] 许永庆[1] 

机构地区：[1]中国医科大学盛京医院普外科,辽宁省沈阳市110004

出　　处：《世界华人消化杂志》2008年第4期446-449,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨胆石症患者十二指肠胆道反流的发生与Oddi括约肌压力之间的关系.方法:采用口服核素观察十二指肠胆道反流的方法,将51例胆道残石患者分为反流组和对照组,并从中随机双盲选择33例患者进行Oddi括约肌测压研究,比较十二指肠胆道反流的发生与Oddi括约肌压力之间是否存在一定的关系.结果:51例行胆道取石T型管引流术后的患者中有16例检测到十二指肠胆道反流(31%);所选择的33例患者中有10例检测到十二指肠胆道反流(反流组),余23例未检测到反流的作为对照组,反流组Oddi括约肌基础压、收缩波幅、胆总管压显著低于对照组(7.2±3.9 mmHg vs 14.7±11.0 mmHg,53.5±24.5 mmHg vs 117.2±65.6 mmHg,5.1±1.6 mmHg vs 11.5±7.4 mmHg,P<0.05).两组十二指肠压(DP)、Oddi括约肌收缩频率(SOF)及收缩间期(SOD)无显著性差异(P>0.05).结论:肠胆反流的发生与Oddi括约肌收缩波幅、基础压及胆肠压力差显著性下降有关,而与Oddi括约肌的收缩频率、间期及十二指肠压无关.AIM： To observe the relationship between duodenobiliary reflux in patients who underwent choledocholithotomy plus T-tube drainage and pressure of Oddi sphincter. METHODS： A total of 51 patients who underwent choledocholithotomy plus T-tube drainage were studied. After duodenobiliary reflux due to oral 185 MBq （5 mCi） of technetium-99m diethylenetriaminepentaacetatic acid （^99mTc-DTPA） was observed, the patients were divided into reflux group positive for duodenobiliary reflux and control group negative for duodenobiliary reflux. Thirty-three of them were selected ran- domly and the pressure of Oddi sphincter was assessed by choledochoscope manometry to find if there is a certain relationship between them. RESULTS： Duodenobiliary reflux was detected in 31% （16/51） of the patients who underwent choledocholithotomy plus T-tube drainage and in 10 of the 33 randomly selected patients, while no duodenobiliary reflux was detected in the remaining 23 patients of the control group. The basal pressure and contraction amplitude of Oddi sphincter and the pressure of common bile duct were significantly lower in the reflux group than in the control group （7.2 ± 3.9 mmHg vs 14.7 ± 11.0 mmHg, 53.5 ± 24.5 mmHg vs 117.2 ± 65.6 mmHg, 5.1 ± 1.6 mmHg vs 11.5 ± 7.4 mmHg, P 〈 0.05）. No significant difference was found in the frequency of contractions, duration of contractions or pressure of common bile duct between the two groups. CONCLUSION： The occurrence of duodenobiliary reflux is related with the contraction amplitude and basal pressure of Oddi sphincter and the common bile duct pressure, but not with the contraction frequency and duration of Oddi sphincter and the pressure of common bile duct. Duodenobiliary reflux may play a role in the pathogenesis of choledocholithiasis.

关 键 词：胆石症 肠胆反流 压力测量法 胆道动力学 

分 类 号：R575.6[医药卫生—消化系统]