【摘要】：目的探討內(nèi)鏡下十二指腸乳頭括約肌切開術(shù)(EST)術(shù)后腸膽反流(DBR)的發(fā)生因素。方法在2012年9月至2016年2月選擇在該院消化科進(jìn)行住院診治的膽總管結(jié)石患者198例,所有患者都給予十二指腸乳頭EST,判斷術(shù)后DBR發(fā)生情況,調(diào)查發(fā)生因素,同時(shí)進(jìn)行奧狄括約肌(Oddi括約肌)功能的測(cè)定與遠(yuǎn)期并發(fā)癥的隨訪。結(jié)果所有患者都順利完成EST,198例患者平均膽總管直徑為(2.24±0.24)cm,平均膽總管結(jié)石數(shù)量為(3.63±1.12)個(gè),膽總管結(jié)石最大直徑為(1.02±0.19)cm。EST術(shù)后出現(xiàn)DBR 12例,發(fā)生率為6.1%,平均放射性活度為(3.39±0.89)MBq。EST術(shù)后Oddi括約肌收縮壓高峰值和收縮頻率分別為(31.49±4.22)mm Hg和(3.78±0.53)次/min,都明顯低于術(shù)前(P0.05);術(shù)后Oddi括約肌基礎(chǔ)壓和膽總管壓力分別為(8.23±1.03)mm Hg和(3.32±0.45)mm Hg,與術(shù)前比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。Logistic回歸分析表明合并膽囊結(jié)石、膽總管直徑、術(shù)前術(shù)后Oddi括約肌收縮頻率差值、結(jié)石數(shù)量、結(jié)石最大直徑為EST術(shù)后DBR發(fā)生的影響因素(P0.05)。所有患者術(shù)后隨訪6個(gè)月,發(fā)生遠(yuǎn)期并發(fā)癥18例,發(fā)生率為9.1%,其中反流性膽管炎4例,膽管狹窄6例,乳頭狹窄4例,結(jié)石復(fù)發(fā)4例。結(jié)論十二指腸乳頭EST術(shù)后DBR比較常見,可導(dǎo)致Oddi括約肌功能下降與遠(yuǎn)期并發(fā)癥的增加,需要積極加強(qiáng)預(yù)防管理。
[Abstract]:Objective to investigate the risk factors of enterobiliary reflux (DBR) after endoscopic sphincterotomy of duodenal papilla (EST). Methods from September 2012 to February 2016, 198 patients with choledocholithiasis who were hospitalized in the Digestive Department of our hospital were selected. All the patients were given duodenal papilla EST, to judge the incidence of DBR after operation, and the occurrence factors were investigated. The function of Oddi sphincter (Oddi sphincter) was measured and the long-term complications were followed up. Results the mean common bile duct diameter of all patients with EST,198 was (2.24 鹵0.24) cm, and the mean number of common bile duct stones was (3.63 鹵1.12). The maximum diameter of choledocholithiasis was (1. 02 鹵0. 19) cm.EST in 12 patients with DBR. The mean activity of Oddi sphincter after MBq.EST was (31.49 鹵4.22) mm Hg and (3.78 鹵0.53) times / min, respectively, which was significantly lower than that before operation (P0.05). Postoperative Oddi sphincter basal pressure and common bile duct pressure were (8.23 鹵1.03) mm Hg) and (3.32 鹵0.45) mm Hg,), respectively. There was no significant difference between before and after operation (P0.05). Logistic regression analysis showed that there was no significant difference in cholecystolithiasis and common bile duct diameter. Before and after Oddi sphincter contraction frequency difference, the number of stones and the maximum diameter of stone were the influencing factors of DBR after EST (P0.05). All the patients were followed up for 6 months, 18 cases (9.1%) had long-term complications, including 4 cases of reflux cholangitis, 6 cases of bile duct stenosis, 4 cases of papillary stenosis and 4 cases of recurrence of stones. Conclusion DBR is common after EST of duodenal papilla, which can lead to the decrease of sphincter function of Oddi and the increase of long-term complications.
【作者單位】： 海南省�？谑腥嗣襻t(yī)院消化內(nèi)科;
【基金】：海南省衛(wèi)生廳項(xiàng)目(瓊衛(wèi)2011-59)
【分類號(hào)】：R657.42

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