Oddi括约肌压力及其开口形态改变与胆石成因的关系
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摘要
目的:对胆道结石患者术后经“T”管窦道行胆道镜观察Oddi括约肌(SO)开口形态变化和测压,探讨胆道结石与SO开口形态、功能变化的关系。
方法:对120例因胆道结石行胆总管探查“T”管引流的患者,术后经“T”管窦道行胆道镜检查,观察SO开口形态,同时测量十二指肠压、Oddi括约肌基础压、收缩幅度、收缩频率、收缩间期、胆总管压以及顺蠕动、逆蠕动及同时收缩所占百分比。根据胆道镜观察结果将SO开口形态分为规则圆点型、狭窄圆点型、放射型、不规则型、鱼口型;根据胆道镜下测压结果将SO基础压分为三组: SO运动功能不足组、SO运动功能正常组、SO运动功能亢进组,比较各组测压指标与SO开口形态变化的关系。
结果:经过对120名患者进行观察SO开口形态和测压研究。其中A组36例,SO开口形态呈不规则型或鱼口型,基础压均值为4.07 mmHg,占30%,为SO运动功能不足组;B组71例,SO开口形态呈规则圆点型或放射状,基础压均值为18.56 mmHg,占59%,为运动功能正常组;C组13人,SO开口形态呈狭窄圆点型,基础压均值为50.25 mmHg,占11%,为SO运动功能亢进组。A组Oddi括约肌基础压、收缩幅度、胆总管压显著低于B组及C组(P<0.05),B组与C组胆总管压差异无显著性(P>0.05),但SO基础压及收缩幅度有显著性差异(P<0.05),A组(SO开口呈鱼口型)收缩频率与其他各组差异显著(P<0.05),各组顺逆蠕动及同时收缩差异无显著性(P>0.05)。
结论:胆道镜下胆道结石患者SO开口形态呈规则圆点型、狭窄圆点型、放射型、不规则型、鱼口型,不同形态的SO可引起SO功能改变,进而导致胆道压力的变化,胆道结石患者术后存在SO运动功能正常、运动功能不足和运动功能亢进三种状况SO运动功能亢进患者的SO开口呈狭窄圆点型,SO基础压升高,可能与胆管结石成因有关,SO运动功能不足患者的SO开口呈不规则型或鱼口型,SO基础压降低,肠胆反流及细菌培养阳性率极高,可能与胆管结石复发和胆管炎有关。
Objective
To study the sphincter of Oddi(SO) manometry and to observe SO changes of shape via choledochofiberscope through“T”tube tract for 120 patients post-biliary exploration. to evaluate its relatationship with bile duct stones.
Methods
one hundred and twenty patients who had a T tube after operations were assessed by choledochoscopic manometry.SO basal pressure(SOBP),amplitude of SO contractions(SOCA),frequncy of SO contractions(SOCF),duration of SO contractions(SOCD),duodenal pressure(DP),common bile duct pressure(CBDP),and the percentage of propagate directions were scored analyzed. According choledochoscopic results will be SO open dots form into regular dot shape, narrow dot shape, radial shape, irregular, fish- mouth shape, The patients were divided into three groups according to the levels of sphincter of Oddi basal pressure: sphincter of Oddi hypomotility、normal SO movement、sphincter of Oddi hypermotility.
Results
there were 36 patients in group A.the mean of SOBP was 4.07 mmHg(30%), SO was irregular shape or fish-mouth shape. there were 71 patients in the B groups. the mean of SOBP was 18.56 mmHg(59%), SO was regular dot shape or radial shape. there were 13 patients in group C. the mean of SOBP was 50.25 mmHg(11%), SO was narrow dot shape. SOBP,SOCA, DP in group A were much lower than B and C group(P<0.05), the mean COBD in group B had no significant difference from that in group C;but SOBD and SOCA in group B were lower than that in group C(P<0.05);SOF in group A(fish-mouth shape) was much lower than that in the other groups(P<0.05).but every group was not statistically different in the percentage of synchronous peristalsis、retrograte peristalsis and comliant peristalsis(P>0.05).
Conclusions
According choledochoscopic results will be divided SO form into regular dot shape, narrow dot shape, radial shape, irregular shape, fish- mouth shape, SO Functional and morphological abnormalities can cause changes in biliary pressure and power ,SO hypomotility , hypermotility and normal exist in bile duct stone patients after operation,which can be diagnosed effectively by choledochoscopic manometry, SO was narrow dot shape. SOBP is increased, which may cause the Bile duct stones ;SO was irregular or fish-mouth shape, SOBP is decreased, duodenal-biliary reflux, and high rate of bacterial culture was positive,it may be associated with the recurrence of bile duct stone and cholangitis.
方法:对120例因胆道结石行胆总管探查“T”管引流的患者,术后经“T”管窦道行胆道镜检查,观察SO开口形态,同时测量十二指肠压、Oddi括约肌基础压、收缩幅度、收缩频率、收缩间期、胆总管压以及顺蠕动、逆蠕动及同时收缩所占百分比。根据胆道镜观察结果将SO开口形态分为规则圆点型、狭窄圆点型、放射型、不规则型、鱼口型;根据胆道镜下测压结果将SO基础压分为三组: SO运动功能不足组、SO运动功能正常组、SO运动功能亢进组,比较各组测压指标与SO开口形态变化的关系。
结果:经过对120名患者进行观察SO开口形态和测压研究。其中A组36例,SO开口形态呈不规则型或鱼口型,基础压均值为4.07 mmHg,占30%,为SO运动功能不足组;B组71例,SO开口形态呈规则圆点型或放射状,基础压均值为18.56 mmHg,占59%,为运动功能正常组;C组13人,SO开口形态呈狭窄圆点型,基础压均值为50.25 mmHg,占11%,为SO运动功能亢进组。A组Oddi括约肌基础压、收缩幅度、胆总管压显著低于B组及C组(P<0.05),B组与C组胆总管压差异无显著性(P>0.05),但SO基础压及收缩幅度有显著性差异(P<0.05),A组(SO开口呈鱼口型)收缩频率与其他各组差异显著(P<0.05),各组顺逆蠕动及同时收缩差异无显著性(P>0.05)。
结论:胆道镜下胆道结石患者SO开口形态呈规则圆点型、狭窄圆点型、放射型、不规则型、鱼口型,不同形态的SO可引起SO功能改变,进而导致胆道压力的变化,胆道结石患者术后存在SO运动功能正常、运动功能不足和运动功能亢进三种状况SO运动功能亢进患者的SO开口呈狭窄圆点型,SO基础压升高,可能与胆管结石成因有关,SO运动功能不足患者的SO开口呈不规则型或鱼口型,SO基础压降低,肠胆反流及细菌培养阳性率极高,可能与胆管结石复发和胆管炎有关。
Objective
To study the sphincter of Oddi(SO) manometry and to observe SO changes of shape via choledochofiberscope through“T”tube tract for 120 patients post-biliary exploration. to evaluate its relatationship with bile duct stones.
Methods
one hundred and twenty patients who had a T tube after operations were assessed by choledochoscopic manometry.SO basal pressure(SOBP),amplitude of SO contractions(SOCA),frequncy of SO contractions(SOCF),duration of SO contractions(SOCD),duodenal pressure(DP),common bile duct pressure(CBDP),and the percentage of propagate directions were scored analyzed. According choledochoscopic results will be SO open dots form into regular dot shape, narrow dot shape, radial shape, irregular, fish- mouth shape, The patients were divided into three groups according to the levels of sphincter of Oddi basal pressure: sphincter of Oddi hypomotility、normal SO movement、sphincter of Oddi hypermotility.
Results
there were 36 patients in group A.the mean of SOBP was 4.07 mmHg(30%), SO was irregular shape or fish-mouth shape. there were 71 patients in the B groups. the mean of SOBP was 18.56 mmHg(59%), SO was regular dot shape or radial shape. there were 13 patients in group C. the mean of SOBP was 50.25 mmHg(11%), SO was narrow dot shape. SOBP,SOCA, DP in group A were much lower than B and C group(P<0.05), the mean COBD in group B had no significant difference from that in group C;but SOBD and SOCA in group B were lower than that in group C(P<0.05);SOF in group A(fish-mouth shape) was much lower than that in the other groups(P<0.05).but every group was not statistically different in the percentage of synchronous peristalsis、retrograte peristalsis and comliant peristalsis(P>0.05).
Conclusions
According choledochoscopic results will be divided SO form into regular dot shape, narrow dot shape, radial shape, irregular shape, fish- mouth shape, SO Functional and morphological abnormalities can cause changes in biliary pressure and power ,SO hypomotility , hypermotility and normal exist in bile duct stone patients after operation,which can be diagnosed effectively by choledochoscopic manometry, SO was narrow dot shape. SOBP is increased, which may cause the Bile duct stones ;SO was irregular or fish-mouth shape, SOBP is decreased, duodenal-biliary reflux, and high rate of bacterial culture was positive,it may be associated with the recurrence of bile duct stone and cholangitis.
引文
1. Mallet-Guy P,Rose JD.Per-operative manometry and radiology in biliary tract disorders .Br J Surg ,1956;44(183):55-68.
2. Roux M, Le Canuet R, Vayre P. Estimation of the function level of the common bile duct by the per-operative study of radio-mano-flowmeter correlations.J Chis (paris),1965;89(5):587-604.
3. Vondrásek P, Eberhardt G. Semiconductors in the recording of pressure during endoscopy. Preliminary report on the technic of measurement. Z Gastroenterol,1974;12(6):453-458.
4.蒋渝,张圣道.胆道压力流量测定在胆总管下端疾病中的应用价值.中华外科杂志,1986;24(4):209-211.
5.莫剑忠,陈晓星,刘文忠,等.内镜下Oddi括约肌压力测定.中华消化杂志,1989;9(4):223-226.
6.孟翔凌,高山城,杜云,等.纤维胆道镜下胆总管下端开口的形态及功能,中华实验外科杂志,1998;11(2):80-81.
7. Lange K, Gottschalk M. Gallbladder contractility in early stages of lithogenic fed guinea pig. J Gastroenterol, 1995;33(6):333-339.
8.杜凡,魏经国,杜宛云.胆囊结石过程Oddi括约肌功能与超微结构.中华肝胆外科杂志,2002;8(10):605-608.
9. Calabuig R,Weems WA,Moody FG. Choledochoduodenal flow;effect of the sphincterof oddi in opossums and cats. Gastroenterology ,1990;99(6):1641-1646.
10. Jordan GL Jr, Choledocholithiasis. Current Problems in Surg,1982 ;19 (12) :722-798.
11.孟翔凌,高山城,杜云,等.胆道镜及胆道测压对胆道下端疾病的诊断价值,中华实用外科杂志,1998;18(7):402-405.
12. Toouli J,Roberts-thomson I, Dent J ,et al . Manometric disorders inpatients with suspected sphincter 0f Oddi dysfunction Gastroenterology.1985;88(7):1243-1250.
13. Uchiyama K,Onishi H,Tani M. Long-term prognosis after treatment of patients with choledocholithiasis.Ann Surg ,2003;238(1):97-102.
14. Osnes T,Sandstad O,Skar V. Lipopolysaccharides and beta—glucuronidase activity incholedochal bile in relation to choledocholithiasis.Digestion 1997;58(5):437-443.
15.Ho KJ,Hsu SC ,Chen JS. Human biliary beta-glucuronidase:correlation of its activity with deconiugation of bilirubin in the bile.Eur J Clin Invest ,1986;16(5):361-367.
16.金俊哲,吴硕东,苏洋,等.肠胆反流对胆管胆色素结石形成的影响,世界华人消化杂志,2006;14(7):727-730.
17.田忠,吴硕东,孔静,等.胆管结石患者术后经“T”管窦道胆道镜Oddi括约肌测压的表现及意义.世界华人消化杂志,2006;14(11):1119-1123.
18. Kozarek RA.Balloon dilation of the sphincter of Oddi.Endoscopy,1988;20(suppl 1):207-210.
19.李荣,全卓勇,邵永胜,等.Oddi括约肌良性病变临床和病理分析,临床外科杂志,2009;17(7):462-463.
20.魏义,张寅,王凯,等.胆管空肠Roux—en—Y吻合与内镜下乳头肌切开术后肠胆反流与胆汁排泄对比研究,肝胆外科杂志,2003;11(2):119-120.
21.Deng ZL,Nabae T,Konomi H,et al. Effects of proximal duodenal transection and anastomosis on interdigestive sphincterof oddi cyclic motility in conscious dogs.World J. Surg,2000;24(7):863—869.
22.Allescher HD,Safrany L,Neuhaus H,et al.Aerobilia andhypomotility of the sphincter of Oddi in a patient with chronicintestinal pseudorobstruction. Gastroenterology,1992;102(5): 1782—1787.
23.Velosy B,Madacsy L,Siepes A,et al.The effects of Somlatostation and octreofide on the human sphincter of Oddi.Eur J Gastroenterol Hepatol,1999;11(8):897-901.
24.Uchida N,Ezaki T,Hirabayashi S,et a1.Endoscopic lithotomy of common bile duct stones with sublingual nitroglycerinand guidewire.Am J Gastroenterol,1997;92(9):1440-1443.
25.吴硕东,金俊哲,姜锡然,等.经胆道镜测压观察硝酸甘油等对Oddi括约肌的作用.消化外科杂志,2002;1(1):40—42.
26. Baker RA,Saccone GT,Toouli J,et a1.Cisapride inhibits motility of the sphincter of Oddi in the Australian possum .Dig Dis Sci,l990;35(6):711-715.
27.Nakayama S,Neya T,Yamasato T,et a1.Effects of cisapride on the motility of the digestive tract in dogs and guinea pigs.Nippon Heikatsulin Gakkai zasshi,1985;21(1):1-9.
28.金俊哲,吴硕东,张振海,等.经胆道镜测压观察硝酸甘油和西沙必利对SO括约肌作用的临床研究.中国新医药,2004;3(4):35-37.
29.Sugiyama M,Atomi Y .Follow-up of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in yong patients.Br J Surg,1998,85(7):917-921.
1.Mallet-Guy P,Rose JD.Per-operative manometry and radiology in biliary tract disorders .Br J Surg ,1956;44(183):55-68.
2.Roux M, Le Canuet R, Vayre P. Estimation of the function level of the common bile duct by the per-operative study of radio-mano-flowmeter correlations.J Chis (paris),1965;89(5):587-604.
3.Vondrásek P, Eberhardt G. Semiconductors in the recording of pressure during endoscopy. Preliminary report on the technic of measurement. Z Gastroenterol,1974;12(6):453-458.
4.蒋渝,张圣道.胆道压力流量测定在胆总管下端疾病中的应用价值.中华外科杂志,1986;24(4):209-211.
5.莫剑忠,陈晓星,刘文忠,等.内镜下Oddi括约肌压力测定.中华消化杂志,1989;9(4):223-226.
6.孙韶龙,崔东旭,戴显伟,等.肠胆反流与Oddi括约肌压力之间的关系.世界华人消化杂志,2008;16(4):446-449.
7.Calabuig R,Weems WA,Moody FG. Choledochoduodenal flow;effect of the sphincterof oddi in opossums and cats. Gastroenterology, 1990;99(6):1641-1646
8. Jordan GL Jr, Choledocholithiasis. Current Problems in Surg,1982 ;19 (12) :722-798.
9.孟翔凌,高山城,杜云,等.胆道镜及胆道测压对胆道下端疾病的诊断价值,中华实用外科杂志,1998,18(7):402-405
10.吴硕东,张振海,金俊哲,等.Oddi括约肌在肠胆反流中作用的研究.中华肝胆外科杂志,2007;13(4):224-227
11.Toouli J,Roberts-thomson I, Dent J ,et al . Manometric disorders inpatients with suspected sphincter 0f Oddi dysfunction Gastroenterology.1985;88(7):1243-1250.
12.田忠,吴硕东,孔静,等.胆管结石患者术后经“T”管窦道胆道镜Oddi括约肌测压的表现及意义,世界华人消化杂志,2006;14(11):1119-1123
13.魏义,张寅,王凯,等.胆管空肠Roux—en—Y吻合与内镜下乳头肌切开术后肠胆反流与胆汁排泄对比研究.肝胆外科杂志,2003;11(2):119-120.
14.Deng ZL,Nabae T,Konomi H,et al. Effects of proximal duodenaI transection and anastomosis on interdigestive sphincterof oddi cyclic motility in conscious dogs.World J Surg,2000;24(7):863-869
15. Allescher HD,Safrany L,Neuhaus H,et al.Aerobilia andhypomotility of the sphincter of Oddi in a patient with chronicintestinal pseudorobstruction. Gastroenterology,1992;102(5):1782-1787
16.王炳煌,朱红,李立春,等.Oddi括约肌与复发性胆管炎胆管结石.肝胆外科杂志,2002;10(1):10-12
17.金俊哲,吴硕东,张振海,等.经胆道镜测压观察硝酸甘油和西沙必利对Oddi括肌作用的临床研究.中国新医药,2004;3(4):35-37
18.张振海,吴硕东,徐健,等.杜冷丁、强痛定及曲吗多对Oddi括约肌压力的影响.山东医药,2008;48(35):39-40
19.张强,吴硕东,王伟,等.吗啡、山莨菪碱及硫酸镁对Oddi括约肌压力的影响.解剖科学进展,2008;14(2):161-164
20.吴硕东,张振海,金俊哲,等.影响奥狄括约肌运动功能药物的胆道镜测压研究.中华医学杂志,2005;85(27):1911-1915
2. Roux M, Le Canuet R, Vayre P. Estimation of the function level of the common bile duct by the per-operative study of radio-mano-flowmeter correlations.J Chis (paris),1965;89(5):587-604.
3. Vondrásek P, Eberhardt G. Semiconductors in the recording of pressure during endoscopy. Preliminary report on the technic of measurement. Z Gastroenterol,1974;12(6):453-458.
4.蒋渝,张圣道.胆道压力流量测定在胆总管下端疾病中的应用价值.中华外科杂志,1986;24(4):209-211.
5.莫剑忠,陈晓星,刘文忠,等.内镜下Oddi括约肌压力测定.中华消化杂志,1989;9(4):223-226.
6.孟翔凌,高山城,杜云,等.纤维胆道镜下胆总管下端开口的形态及功能,中华实验外科杂志,1998;11(2):80-81.
7. Lange K, Gottschalk M. Gallbladder contractility in early stages of lithogenic fed guinea pig. J Gastroenterol, 1995;33(6):333-339.
8.杜凡,魏经国,杜宛云.胆囊结石过程Oddi括约肌功能与超微结构.中华肝胆外科杂志,2002;8(10):605-608.
9. Calabuig R,Weems WA,Moody FG. Choledochoduodenal flow;effect of the sphincterof oddi in opossums and cats. Gastroenterology ,1990;99(6):1641-1646.
10. Jordan GL Jr, Choledocholithiasis. Current Problems in Surg,1982 ;19 (12) :722-798.
11.孟翔凌,高山城,杜云,等.胆道镜及胆道测压对胆道下端疾病的诊断价值,中华实用外科杂志,1998;18(7):402-405.
12. Toouli J,Roberts-thomson I, Dent J ,et al . Manometric disorders inpatients with suspected sphincter 0f Oddi dysfunction Gastroenterology.1985;88(7):1243-1250.
13. Uchiyama K,Onishi H,Tani M. Long-term prognosis after treatment of patients with choledocholithiasis.Ann Surg ,2003;238(1):97-102.
14. Osnes T,Sandstad O,Skar V. Lipopolysaccharides and beta—glucuronidase activity incholedochal bile in relation to choledocholithiasis.Digestion 1997;58(5):437-443.
15.Ho KJ,Hsu SC ,Chen JS. Human biliary beta-glucuronidase:correlation of its activity with deconiugation of bilirubin in the bile.Eur J Clin Invest ,1986;16(5):361-367.
16.金俊哲,吴硕东,苏洋,等.肠胆反流对胆管胆色素结石形成的影响,世界华人消化杂志,2006;14(7):727-730.
17.田忠,吴硕东,孔静,等.胆管结石患者术后经“T”管窦道胆道镜Oddi括约肌测压的表现及意义.世界华人消化杂志,2006;14(11):1119-1123.
18. Kozarek RA.Balloon dilation of the sphincter of Oddi.Endoscopy,1988;20(suppl 1):207-210.
19.李荣,全卓勇,邵永胜,等.Oddi括约肌良性病变临床和病理分析,临床外科杂志,2009;17(7):462-463.
20.魏义,张寅,王凯,等.胆管空肠Roux—en—Y吻合与内镜下乳头肌切开术后肠胆反流与胆汁排泄对比研究,肝胆外科杂志,2003;11(2):119-120.
21.Deng ZL,Nabae T,Konomi H,et al. Effects of proximal duodenal transection and anastomosis on interdigestive sphincterof oddi cyclic motility in conscious dogs.World J. Surg,2000;24(7):863—869.
22.Allescher HD,Safrany L,Neuhaus H,et al.Aerobilia andhypomotility of the sphincter of Oddi in a patient with chronicintestinal pseudorobstruction. Gastroenterology,1992;102(5): 1782—1787.
23.Velosy B,Madacsy L,Siepes A,et al.The effects of Somlatostation and octreofide on the human sphincter of Oddi.Eur J Gastroenterol Hepatol,1999;11(8):897-901.
24.Uchida N,Ezaki T,Hirabayashi S,et a1.Endoscopic lithotomy of common bile duct stones with sublingual nitroglycerinand guidewire.Am J Gastroenterol,1997;92(9):1440-1443.
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