EST对Oddi括约肌功能影响的临床研究

发布时间：2018-04-21 17:13

本文选题：Oddi括约肌 + 内镜下括约肌切开术　；参考：《昆明医科大学》2015年硕士论文

【摘要】：[目的]：对比分析研究内镜下括约肌切开术(Endoscopic shphincterotomy, EST)的切口长度、是否行鼻胆管引流对Oddi括约肌(Sphincter of Oddi SO)功能的影响。[方法]：收集昆明医科大学第二附属医院肝胆外二科2012年1月—2013年12月期间行EST治疗的肝外胆管结石患者114例的临床资料并进行分组,其中行鼻胆管引流73例(A组),未行鼻胆管引流有41例(B组),EST切口长度0.8cm有46例(C组),0.8cm有68例(D组),回顾性分析SO切口长度、是否行鼻胆管引流对SO功能的影响。1.所有患者术后3天、7天复查肝功能、血细胞分析、血淀粉酶,并对A、B组两者之间作分析对比。2.所有患者术后一周、半年、一年进行临床随访并予钡餐检查,并对C、D组两者之间作分析对比。3.根据EST术后并发症的诊断标准评定患者是否发生并发症,并对C、D组两者之间作分析对比。数据处理：实验数据采用SPSS17.0统计软件进行统计学分析,符合正态分布的计量资料采用均数±标准((X±S))差表示,比较采用X2检验,P0.05差异有统计学意义。[结果]：1.EST术3天后复查肝功能、血淀粉酶,发现B组患者谷丙转氨酶(Alanine aminotransferase, ALT)、直接胆红素(Direct bilirubin, DBIL)、血淀粉酶(Amylase AMS)较A组高,对比分析有统计学差异(P0.05),谷草转氨酶(Aspartate aminotransferase, AST)、碱性磷酸酶(Alkaline phosphatase, AKP)对比分析无统计学意义(P0.05),白细胞升高患者有5例。7天复查后白细胞正常,ALT、DBIL、AMS、AST、AKP无明显差异,对比分析无统计学意义(P0.05)。2.EST术后7天22例出现胆管积气,C组有13例,D组有9例,钡剂返流15例,C组有10例,D组有5例。半年胆管积气12例,C组有8例,D组有4例,钡剂返流10例,C组有7例,D组有3例。一年胆管积气4例,C组有4例,D组有0例,钡剂返流3例,C组有3例,D组0例。EST切口越大损伤越重,发生胆管积气和钡剂返流的风险越大。SO切口长度与胆管积气和钡剂返流的发生率对比分析有统计学意义。3.发生并发症8例,C组有6例,D组有2例,EST切口越大发生并发症的风险越大,SO切口长度与并发症发生比较有统计学意义。[结论]：1.EST术后短期对SO有直接损伤,而鼻胆管引流对EST术后胆汁胰液的引流是有效的。2.胆管积气和钡剂返流说明乳头肌功能不良,EST切口越大损伤越重,发生胆管积气和钡剂返流的风险越大。3.EST术后出现的并发症与SO切开长度有关,EST术的切口长度越大发生并发症风险越大。
[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 卤standard X 卤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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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