本文選題：Oddi括約肌 + 內(nèi)鏡下括約肌切開術(shù)�。� 參考：《昆明醫(yī)科大學》2015年碩士論文

【摘要】：[目的]：對比分析研究內(nèi)鏡下括約肌切開術(shù)(Endoscopic shphincterotomy, EST)的切口長度、是否行鼻膽管引流對Oddi括約肌(Sphincter of Oddi SO)功能的影響。[方法]：收集昆明醫(yī)科大學第二附屬醫(yī)院肝膽外二科2012年1月—2013年12月期間行EST治療的肝外膽管結(jié)石患者114例的臨床資料并進行分組,其中行鼻膽管引流73例(A組),未行鼻膽管引流有41例(B組),EST切口長度0.8cm有46例(C組),0.8cm有68例(D組),回顧性分析SO切口長度、是否行鼻膽管引流對SO功能的影響。1.所有患者術(shù)后3天、7天復查肝功能、血細胞分析、血淀粉酶,并對A、B組兩者之間作分析對比。2.所有患者術(shù)后一周、半年、一年進行臨床隨訪并予鋇餐檢查,并對C、D組兩者之間作分析對比。3.根據(jù)EST術(shù)后并發(fā)癥的診斷標準評定患者是否發(fā)生并發(fā)癥,并對C、D組兩者之間作分析對比。數(shù)據(jù)處理：實驗數(shù)據(jù)采用SPSS17.0統(tǒng)計軟件進行統(tǒng)計學分析,符合正態(tài)分布的計量資料采用均數(shù)±標準((X±S))差表示,比較采用X2檢驗,P0.05差異有統(tǒng)計學意義。[結(jié)果]：1.EST術(shù)3天后復查肝功能、血淀粉酶,發(fā)現(xiàn)B組患者谷丙轉(zhuǎn)氨酶(Alanine aminotransferase, ALT)、直接膽紅素(Direct bilirubin, DBIL)、血淀粉酶(Amylase AMS)較A組高,對比分析有統(tǒng)計學差異(P0.05),谷草轉(zhuǎn)氨酶(Aspartate aminotransferase, AST)、堿性磷酸酶(Alkaline phosphatase, AKP)對比分析無統(tǒng)計學意義(P0.05),白細胞升高患者有5例。7天復查后白細胞正常,ALT、DBIL、AMS、AST、AKP無明顯差異,對比分析無統(tǒng)計學意義(P0.05)。2.EST術(shù)后7天22例出現(xiàn)膽管積氣,C組有13例,D組有9例,鋇劑返流15例,C組有10例,D組有5例。半年膽管積氣12例,C組有8例,D組有4例,鋇劑返流10例,C組有7例,D組有3例。一年膽管積氣4例,C組有4例,D組有0例,鋇劑返流3例,C組有3例,D組0例。EST切口越大損傷越重,發(fā)生膽管積氣和鋇劑返流的風險越大。SO切口長度與膽管積氣和鋇劑返流的發(fā)生率對比分析有統(tǒng)計學意義。3.發(fā)生并發(fā)癥8例,C組有6例,D組有2例,EST切口越大發(fā)生并發(fā)癥的風險越大,SO切口長度與并發(fā)癥發(fā)生比較有統(tǒng)計學意義。[結(jié)論]：1.EST術(shù)后短期對SO有直接損傷,而鼻膽管引流對EST術(shù)后膽汁胰液的引流是有效的。2.膽管積氣和鋇劑返流說明乳頭肌功能不良,EST切口越大損傷越重,發(fā)生膽管積氣和鋇劑返流的風險越大。3.EST術(shù)后出現(xiàn)的并發(fā)癥與SO切開長度有關(guān),EST術(shù)的切口長度越大發(fā)生并發(fā)癥風險越大。
[Abstract]:Objective: to compare and analyze the effect of endoscopic sphincterotomy on the function of Oddi sphincter of Oddi so. Methods: the clinical data of 114 patients with extrahepatic cholelithiasis treated with EST from January 2012 to December 2013 in the second affiliated Hospital of Kunming Medical University were collected and divided into two groups. There were 73 cases of nasobiliary drainage in group A and 41 cases in group B without nasobiliary drainage. There were 46 cases in group C and 68 cases in group D with EST incision length. The length of so incision and the effect of nasobiliary drainage on the function of so were analyzed retrospectively. All patients were examined liver function, blood cell analysis, and serum amylase on the 3rd and 7th day after operation. All patients were followed up for one week, six months and one year after operation and barium meal examination was performed. According to the diagnostic criteria of complications after EST, the complications were evaluated and compared between the two groups. Data processing: SPSS17.0 statistical software was used to analyze the experimental data. The measurement data in accordance with the normal distribution were expressed by the mean 鹵standard X 鹵Ser difference, and the difference was statistically significant by using X2 test (P0.05). [results] 1. After 3 days of EST, liver function and serum amylase were examined. It was found that alanine aminotransferase (alt), direct bilirubin (DBILB), serum amylase (Amylase AMSs) in group B were higher than those in group A. There was no statistically significant difference between the two groups (P 0.05). There was no significant difference in alkaline phosphatase (ALP) and alkaline phosphatase (ALP). There was no significant difference in ALT DBILAMS ASTAKP in 5 patients with leukocytosis after reexamination for 7 days. There were 13 cases in group C and 9 cases in group D, and 10 cases in group C and 5 cases in group D, respectively. There were 8 cases in group D and 4 cases in group D in 12 cases of bile duct accumulation and 7 cases in group D in 10 cases of barium reflux. There were 4 cases in group C and 0 cases in group D, and 3 cases in group C with barium reflux. There were 0 cases in group D and 0 cases in group D. The larger the incision was, the more serious the injury was. The risk of bile duct accumulation and barium regurgitation was higher. There was significant difference between the incision length of so and the incidence of bile duct accumulation gas and barium reflux. Complications occurred in group C (n = 6) and group D (n = 2). The greater the risk of complications was, the greater the risk of complications. The length of so incision was significantly different from the incidence of complications. [conclusion] 1. EST has direct injury to so in a short period of time, and nasobiliary drainage is effective in drainage of bile and pancreatic juice after EST. Bile duct gas accumulation and barium reflux showed that the greater the injury of EST incision, the more serious the injury of papillary muscle dysfunction. The greater the risk of bile duct gas accumulation and barium reflux. 3. The greater the incision length of EST, the greater the risk of complications after EST.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.4

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本文編號：1783339