内镜下十二指肠乳头括约肌切开和球囊扩张对胆囊功能影响的研究  

The study in effects of EST and EPBD on gallbladder function

作　　者：胡亦懿[1,2] 杜国平[2] 李凤棉[2] 胡元元[2] 智发朝[1] 张亚历[1] 

机构地区：[1]南方医科大学南方医院消化内科,广州510515 [2]南方医科大学非直属附属顺德第一人民医院

出　　处：《中华消化内镜杂志》2014年第1期9-13,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜下胆总管取石术中十二指肠乳头括约肌不同处理方式对患者术后胆囊功能的影响。方法选择58名曾经接受内镜下胆总管取石术的患者，根据治疗方式不同分为3组，十二指肠乳头括约肌大切开组21例、中小切开组20例、球囊扩张组17例，另选择20例健康体检者作为对照。所有患者均采用^99m Tc—EHIDA肝胆动态核素显像进行定量分析，通过肝脏半排时间（TEK），胆总管高峰时间（CBD Tup），胆囊显影时间（GBVT），胆囊的半排时间（GBT1/2），30min胆囊排空分数（GBEF30min），30min胆囊排空率（GBER 30min），十二指肠显影时间（DUT），十二指肠高峰时间（DU Tup）和胆肠分配比（Fgb，Fsi）综合评价胆囊的功能。结果括约肌大切开组分别与其余两治疗组及对照组比较，TEX明显缩短（P〈0．05）；CBD Tup、DUT、DU Tup出现的时间较早（P〈0．05）；GBVT时间延迟（P〈0．001）；GBT1／2缩短（P〈0．001），GBEF30min较大（P〈0．001），GBER 30min较快（P〈0．001），胆肠分配比胆囊的比例Fgb明显减少（P〈0．001），肠道比例Fsi增加（P〈0．001）。EST中小切开组、EBPD组和对照组各参数比较，差异均无统计学意义（P〉0．05）。结论EST大切开患者胆囊贮存功能明显受损，排泄功能增强；EST中小切开及EPBD患者胆囊贮存及排泄功能无明显改变。Objective To investigate the effect of EST and EPBD on the gallbladder function. Methods Fifty-eight patients who underwent common bile duct lithotomy were divided into three groups, the EST major incision group （21）, the EST minor incision group （20） and the endoscopic papillary balloon dilation group （17）. Twenty healthy people were involved as the control group. The hepatobiliary dynamic imaging was used to evaluate the gallbladder function, indices including （ 1 ） Half time of liver excretion （Trx）, （2）Peak time of common bile duct excretion（ CBD Tup）, （3）Gallbladder imaging time （GBVT）, （4） Half time of gallbladder excretion （GBT1/2 ）, （5）Gallbladder excretion fraction at the 30th minute （GBEF3Omin）, （6） Gallbladder excretion rate at the 30th minute （GBER 30 rain） , （7）Duodenum ima-ging time （DUT）, （8）Peak time of bile flowing in duodenal （DU Tup）, （9） Bile ratio in gallbladder at the 30th minute（Fgb）, （10）Bile ratio in intestinal at the 30th minute（Fsi）. Effects of the three operative methods on the gallbladder function were evaluated. Results Compared with the other two treatment groups and control group respectively, the Trx of the EST major incision group was significantly shorter （ P 〈 0.05 ）, CBD Tup, DUT and DU Tup appeared earlier （P 〈0. 05）, GBVT was delayed （P 〈0. 001 ）, GBT1/2 was shorter （P 〈0. 001 ）, GBEF 30 min was higher （P 〈0. 001 ） and GBER 30 min was faster （P 〈0. 001 ） in this group. Gallbladder and intestines ratio （ Fgb, Fsi ） at the 30th minute were significantly different （P 〈1. 001 ） with Fgb reducing while Fsi increasing in this group, compared with others. Compared with the con-trol group respectively, neither the minor incision group nor the EPBD group （P 〉 0. 05） showed significant differences in these indices. Conclusion The storage function of gallbladder has been injured and excretion has been enhanced after EST major incision. Neither

关 键 词：括约肌切开术 内窥镜 胰胆管造影术 内窥镜逆行 胆囊造影术 球囊扩张术 

分 类 号：R657.4[医药卫生—外科学]