內鏡下十二指腸乳頭括約肌切開術后腸膽反流的發(fā)生因素分析
發(fā)布時間：2019-02-11 18:33
【摘要】：目的探討內鏡下十二指腸乳頭括約肌切開術(EST)術后腸膽反流(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行住院診治的膽總管結石患者198例,所有患者都給予十二指腸乳頭EST,判斷術后DBR發(fā)生情況,調查發(fā)生因素,同時進行奧狄括約肌(Oddi括約肌)功能的測定與遠期并發(fā)癥的隨訪。結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,平均膽總管結石數(shù)量為(3.63±1.12)個,膽總管結石最大直徑為(1.02±0.19)cm。EST術后出現(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,都明顯低于術前(P0.05);術后Oddi括約肌基礎壓和膽總管壓力分別為(8.23±1.03)mm Hg和(3.32±0.45)mm Hg,與術前比較差異無統(tǒng)計學意義(P0.05)。Logistic回歸分析表明合并膽囊結石、膽總管直徑、術前術后Oddi括約肌收縮頻率差值、結石數(shù)量、結石最大直徑為EST術后DBR發(fā)生的影響因素(P0.05)。所有患者術后隨訪6個月,發(fā)生遠期并發(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,結石復發(fā)4例。結論十二指腸乳頭EST術后DBR比較常見,可導致Oddi括約肌功能下降與遠期并發(fā)癥的增加,需要積極加強預防管理。
[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】： 海南省海口市人民醫(yī)院消化內科;
【基金】：海南省衛(wèi)生廳項目(瓊衛(wèi)2011-59)
【分類號】：R657.42
本文編號：2419992
[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】： 海南省海口市人民醫(yī)院消化內科;
【基金】：海南省衛(wèi)生廳項目(瓊衛(wèi)2011-59)
【分類號】：R657.42
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