摘要
目的探讨十二指肠乳头旁憩室对胆总管结石形成及取石术后胆道压力的影响。方法选择天津市南开医院微创外科中心2011年5月至2014年3月成功行胆道测压和十二指肠镜诊疗的97例胆总管结石患者，根据是否伴有十二指肠乳头旁憩室分为观察组（伴十二指肠乳头旁憩室）52例和对照组（不伴十二指肠乳头旁憩室）45例，对比分析2组经内镜乳头括约肌切开术（EST）术前及取石后胆道压力。结果EST术前观察组Oddi括约肌基础压明显高于对照组[（84．8±26．1）mmHg比（75．5±14．6）mmHg，P〈0．05]（1mmHg=0．133kPa），取石后观察组Oddi括约肌基础压亦明显高于对照组[（19．8±14．2）mmHg比（15．9±9．8）mmHg，P〈0．05]；EST术前及取石后观察组胆总管内压均高于对照组，但差异无统计学意义（P〉0．05）。出院后1个月随访时，有81例患者再次行胆道测压检查（观察组45例、对照组36例），观察组Oddi括约肌基础压仍明显高于对照组[（34．8±17．1）mmHg比（29．6±15．3）mmHg，P〈0．05]，胆总管内压亦明显高于对照组[（19．9±11．2）mmHg比（17．1±13．1）mmHg，P〈0．05]。结论十二指肠乳头旁憩室的存在，增加了胆总管和Oddi括约肌的压力，促进了胆石的形成。
Objective To explore the impact of juxtapapilary duodenal diverticulum on the formation of choledocholithiasis and biliary manometry after surgery. Methods The clinical data of 97 patients with common bile duct stones who successfully underwent ERCP and biliary manometry treatment from May 2011 to March 2014 were retrospectively analyzed. Ninty-seven common bile duct stone patients were divided to two groups, that is, 52 cases of juxta-papilary duodenal diverticulum （experimental group） and 45 cases without juxta-papilary duodenal diverticulum （control group）. The biliary manometric results before and after EST of both groups were compared. Results The basal pressure of sphincter Oddi of the experimental group before EST [ （ 84. 8 ± 26. 1 ） mmHg ] was higher than that of the control group before EST [ （ 75. 5 ± 14. 6） mmHg ] （ P 〈 0.05, 1 mmHg = 0. 133 kPa） ; and that after EST was also higher than that of the control group after the operation [ （ 19. 8 ± 1. 2） mmHg VS （ 15.9 ± 9. 8 ） mmHg, P 〈 0. 05 ]. The biliary pressure of common bile duct stone patients with JPD was higher than those without JPD before and after EST but with no significant difference（P 〉 0.05 ）. The biliary manometry was performed in 81 patients after one month and it was found that the basal pressure of sphincter Oddi of experimental group was still higher than that of the control group [ （ 34. 8 ± 17.1 ） mmHg VS （29. 6 ± 15.3 ） mmHg, P 〈 0. 05 ]. The biliary pressure of common bile of the experimental group was higher than that of the control group[ （19. 9 ±11.2）mmHg VS （17. 1 ±13. 1 ）mmHg,P 〈0. 05 ]. Conclusion The existence of juxtapapilary duodenal diverticulum increases the pressure of common bile duct and Oddi sphincter and leads to CBD stones.
出处
《中华消化内镜杂志》
北大核心
2015年第7期457-461,共5页
Chinese Journal of Digestive Endoscopy
关键词
胆道测压
十二指肠乳头旁憩室
胰胆管造影术
内窥镜逆行
胆总管结石
Oddi括约肌压力
胆管内压力
Biliary manometry
Juxta-papilary duodenal diverticulum
Cholangiopancreatography, endoscopic retrograde
Choledocholithiasis
Sphincter of Oddi pressure
Common bile duct pressure
