内镜下十二指肠乳头括约肌切开术后肠胆反流的发生因素分析
发布时间：2019-02-11 18:33
【摘要】：目的探讨内镜下十二指肠乳头括约肌切开术(EST)术后肠胆反流(DBR)的发生因素。方法在2012年9月至2016年2月选择在该院消化科进行住院诊治的胆总管结石患者198例,所有患者都给予十二指肠乳头EST,判断术后DBR发生情况,调查发生因素,同时进行奥狄括约肌(Oddi括约肌)功能的测定与远期并发症的随访。结果所有患者都顺利完成EST,198例患者平均胆总管直径为(2.24±0.24)cm,平均胆总管结石数量为(3.63±1.12)个,胆总管结石最大直径为(1.02±0.19)cm。EST术后出现DBR 12例,发生率为6.1%,平均放射性活度为(3.39±0.89)MBq。EST术后Oddi括约肌收缩压高峰值和收缩频率分别为(31.49±4.22)mm Hg和(3.78±0.53)次/min,都明显低于术前(P0.05);术后Oddi括约肌基础压和胆总管压力分别为(8.23±1.03)mm Hg和(3.32±0.45)mm Hg,与术前比较差异无统计学意义(P0.05)。Logistic回归分析表明合并胆囊结石、胆总管直径、术前术后Oddi括约肌收缩频率差值、结石数量、结石最大直径为EST术后DBR发生的影响因素(P0.05)。所有患者术后随访6个月,发生远期并发症18例,发生率为9.1%,其中反流性胆管炎4例,胆管狭窄6例,乳头狭窄4例,结石复发4例。结论十二指肠乳头EST术后DBR比较常见,可导致Oddi括约肌功能下降与远期并发症的增加,需要积极加强预防管理。
[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 卤0.24) cm, and the mean number of common bile duct stones was (3.63 卤1.12). The maximum diameter of choledocholithiasis was (1. 02 卤0. 19) cm.EST in 12 patients with DBR. The mean activity of Oddi sphincter after MBq.EST was (31.49 卤4.22) mm Hg and (3.78 卤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 卤1.03) mm Hg) and (3.32 卤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.
【作者单位】： 海南省海口市人民医院消化内科;
【基金】：海南省卫生厅项目(琼卫2011-59)
【分类号】：R657.42
本文编号：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 卤0.24) cm, and the mean number of common bile duct stones was (3.63 卤1.12). The maximum diameter of choledocholithiasis was (1. 02 卤0. 19) cm.EST in 12 patients with DBR. The mean activity of Oddi sphincter after MBq.EST was (31.49 卤4.22) mm Hg and (3.78 卤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 卤1.03) mm Hg) and (3.32 卤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.
【作者单位】： 海南省海口市人民医院消化内科;
【基金】：海南省卫生厅项目(琼卫2011-59)
【分类号】：R657.42
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