不同术式经内镜下行乳头括约肌切开术(EST)对老年人胆总管结石术后肠胆反流的影响  

The Effect on Duodenal-Intestinal Reflux in Different Endoscopic Sphincterotomy(EST)

作　　者：傅骏[1] 曹中伟[2] 曹超[2] 刑岩[2] 陈海曦[2] 黄春兰[2] 陆颖影[2] 曾悦[2] 

机构地区：[1]上海市第八人民医院结直肠外科,上海200235 [2]上海交通大学附属第一人民医院,上海200080

出　　处：《成都医学院学报》2013年第4期388-392,共5页Journal of Chengdu Medical College

基　　金：国家自然科学基金项目(NO:81200322;No:81200286);上海市卫生局面上项目(NO:2009079)

摘　　要：目的文章报道了采用不同术式的经内镜下行乳头括约肌切开术(EST),即EST中切口和EST小切口+球囊扩张(EPBD)术,以及老年胆总管结石病人术后所引起的十二指肠胆道反流现象和胆管炎的情况,旨在为老年人胆总管结石微创治疗的术式选择提供理论依据。方法 24例老年性胆总管结石患者,男14例,女10例,予行经内镜下逆行的胆胰管造影(ERCP)后分别采用不同术式EST,术后安放胆总管引流管。术后1w留取胆汁,口服核素以及测定胆汁中的胃蛋白酶Ⅰ、Ⅱ的浓度,对十二指肠胆道反流进行定量和定性测定。观察术后1w、6个月口服稀钡患者的十二指肠胆道反流情况,同时观察近期和远期患者继发胆管炎的情况。结果 EST中切口术组、EST小切口+EPBD组分别与无EST组相比,年龄和性别差异无统计学意义(P=0.53,P=0.51)。行EST中切口和EST小切口+EPBD患者胆汁中的锝计数明显高于无EST组,且两组不同术式患者锝计数比较差异有统计学意义(P<0.05)。行EST中切口者、EST小切口+EPBD术者胆汁中的PGⅡ质量浓度明显低于无EST组(P<0.05),但是EST中切口者和EST小切口+EPBD术后两组间胆汁中PGⅡ的质量浓度差异无统计学意义。术后1w、6月的X线稀钡钡餐检查显示中切口EST者发生气体反流分别为2例、1例,钡剂反流分别均为1例。小切口EST+EPBD者发生气体反流分别2例、0例,无钡剂反流现象出现。术后1w无1例出现发热、黄疸和白细胞增高的胆管炎表现。术后6个月中切口EST患者,1例出现轻度胆管炎表现。结论行EST中切口治疗胆总管结石的老年患者在手术早期较易发生十二指肠胆道的反流。因此,建议胆总管结石患者尽量选择行EST小切口+EPBD的手术方式。Objective This article studied duodenal-biliary reflux and cholangitis after different EST which included middle-incision EST and minor-incision EST2- EPBD （endoscopic papillary balloon dilation） in treating common bile duct stone of elderly in order to provide the basis for choosing mini-invasive therapy. Method 24 patients with common bile stones were enrolled in this study. Male patients were 14 and females were 10. They underwent endoscopic retrograde cholangiopancreatography （ERCP） followed by middle-incision EST or minor- incision EST＋ EPBD operation. The drainage tube of common bile duct was placed after ERCP, One week after operation, bile was collected from the drainage tube of common bile duct. Pepsinogen I and pepsinogen Ⅱ in bile collected from drainage tube of common bile duct were measured by enzyme linked immunosorbent assay （ELISA） for qualitative analysis of duodenal-biliary reflux. Patients also took orally 185 MBq of ^99mTc DTPA and ^99mTc DTPA for quantitative analysis of duodenal biliary reflux 1 week and 6 months thereafter. Results There was no statistically difference in gender and age in middle incision EST and minor incision EST＋EPBD compared with controld group（p =0.07,p=0. 416）. The radioactivities in the bile were higher in EST middle incision groups andEST minor-incision＋EPBD groups than in control group. There was significant difference in radioactivity between EST middle-incision and EST minor-incision＋EPBD group （P〈0.05）. The concentrations of pepsinogen Ⅱ in EST middle incision groups and EST minor-incision＋EPBD groups were decreased compared with control group（P〈0. 05）. However, the concentration of pepsinogen Ⅱ was not defferent between EST middle-incision and EST minor incision＋EPBD group. In middle-incision EST, the ratse of gas reflux were 2 （28.5%） and 1 of 7 cases （14.3%） 1 week and 6 months after therapy. In minor EST, the patient numbers of gas reflux were 2 （16.7%）and 0 （0%） of 12 cases 1 week and 6 months af

关 键 词：胆石症 老年 肠胆反流 经内镜下乳头括约肌切开术 

分 类 号：R657.42[医药卫生—外科学]