Oddi括约肌压力对胰液胆管逆流的影响  

Impact of basal sphincter of Oddi pressure on pancreatobiliary reflux

作　　者：祝喜萍[1] 任旭[2] 姜虹[2] 李宁[2] 张玲玲[2] 

机构地区：[1]黑龙江中医药大学,150040 [2]黑龙江省医院消化病院,2150001

出　　处：《现代消化及介入诊疗》2013年第2期80-82,86,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的探讨正常胰胆管汇合Oddi括约肌(SO)压力对胰液胆管逆流(PBR)的影响。方法选择因胆道疾病需要ERCP治疗的患者作为研究对象。ERCP时测SO基础压力、取胆汁测胆汁淀粉酶(BA)及细菌培养。结果 83例中正常组21例,9例(42.9%)BA升高;升高组47例,SO压力与BA值呈负相关(r=-0.43),28例(59.6%)BA升高。两组间PBR发生的频度、其BA值及细菌培养阳性率差异均无统计学意义(P>0.05)。升高组中胆总管直径≥15mm与<15mm比较,BA值明显升高(P<0.05)。EST组(15例)与完整乳头组(正常组和升高组)比较,PBR发生的频度和细菌培养阳性率差异有统计学意义(P<0.05)。结论 SO基础压力升高不是影响PBR的直接因素,但胆管显著扩张时会导致BA值升高。EST可能有利于逆流胰液的排出。Objective To explore the impact of basal sphincter of Oddi （SO） pressure on pancreatobiliary reflux （PBR）. Methods The consecutive patients hospitalized for therapeutic ERCP due to biliary tract dis- eases （with or without endoscopic sphincterotomy, EST） were enrolled in this study. SO manometry（SOM） was conducted to measure the basal sphincter pressure. Meanwhile, bile was sampled during ERCP for bile amylase （BA） detection and bacteria culture. All patients were assigned into three groups： normal basal sphincter pres- sure group, elevated basal pressure group, and EST group （with the history of EST）. Data of the three groups went through statistical analysis. Results A total of 83 patients were included in this study. In normal basal sphincter pressure group without the history of EST （21patients）, 9 patients （42.9%） were detected with elevat- ed BA. While in elevated basal sphincter pressure group （47 patients）, 28 patients （59.6%） were with elevated BA. Negative correlation was seen between SO pressure and BA（r = - 0.43）in this group. There were no sta- tistical differences in the frequency of pancreatobiliary reflux （PBR）, value of elevated BA and the positive rate of bacteria culture between the two groups above （P 〉 0.05）. In the elevated pressure group, however, the me- dian BA value was significantly higher in the patients with common bile duct diameter no less than 15ram than those with the diameter less than 15 mm. Furthermore, significant difference in both the frequency of PBR and the positive rate of bacteria culture was seen between the former two groups （patients with intact papilla） and the EST group （P 〈 0.05）. Conclusions Although there was no direct link between the elevation of basal SO pressure and PBR, marked increase in diameter of common bile duct can lead to a rise in BA. Moreover, EST may facilitate the outflow of the pancreatic juice by relieving cholestasis.

关 键 词：Oddi括约肌压力测定(SOM) 正常胰胆管汇合 胆汁淀粉酶(BA) 胰液胆管逆流(PBR) 

分 类 号：R657.4[医药卫生—外科学]