摘要
目的探索内镜下十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗Oddi括约肌功能障碍(sphincter of Oddi dysfunction,SOD)的有效性和安全性。方法回顾性分析2014年1月至2019年1月期间贵州医科大学附属医院及贵州医科大学附属肿瘤医院收治并行EST治疗的95例SOD患者的临床资料,评价分析EST对SOD患者的临床诊治效果。结果95例SOD患者中,包括胆管型SOD 86例,胰管型SOD 9例。95例患者均行EST治疗,治疗前的5点口述评分法(verbal rating scales-5,VRS-5)评分均为3分或4分,各型SOD患者治疗后VRS-5评分有所降低,差异均有统计学意义(P<0.05)。胆管型SODⅠ和Ⅱ型患者治疗后ALT、AST、ALP、GGT、TBiL和DBiL水平较术前下降(P<0.05);胰管型SOD患者治疗后ALT、AST、ALP、GGT、血清淀粉酶和尿液淀粉酶水平较术前下降(P<0.05),胆管型SODⅢ型患者治疗前后的生化指标变化不大(P>0.05)。86例胆管型SOD患者经EST治疗后,显效70例(81.4%),有效10例(11.6%),总体有效率为93.0%(80/86);其中16例Ⅰ型患者显效14例(87.5%),有效1例(6.3%),总体有效率为93.8%(15/16);51例Ⅱ型患者显效43例(84.3%),有效6例(11.8%),总体有效率为96.1%(49/51);19例Ⅲ型患者显效13例(68.4%),有效3例(15.8%),总体有效率为84.2%(16/19)。3型胆管型SOD患者的总体有效率比较差异无统计学意义(P>0.05)。9例胰管型SOD患者行内镜治疗后全部显效,总体有效率为100%。术后出现急性胰腺炎5例(5.3%),无出血、穿孔、胆管炎等并发症发生。术后所有患者均获访1~5年,中位随访时间为2.33年,随访期间无Oddi括约肌再狭窄、肠胆反流致胆管炎等远期并发症发生。结论EST是一种微创、安全和有效的治疗手段,对胆管型及胰管型SOD患者的治疗效果显著,是SOD的重要治疗方法。
Objective To explore the efficacy and safety of endoscopic sphincterotomy(EST)in the treatment of sphincter of Oddi dysfunction(SOD).Methods The clinical data of 95 cases of SOD treated with EST in Affiliated Hospital of Guizhou Medical University and Tumor Hospital Affiliated to Guizhou Medical University from January 2014 to January 2019 were collected retrospectively,to evaluate and analyze the effect of clinical diagnosis and treatment of EST on SOD patients.Results Among 95 SOD patients,86 were biliary type SOD and 9 were pancreatic type SOD.All 95 patients underwent EST.The Verbal Rating Scales-5(VRS-5)scores before EST were all 3 or 4 points,and the VRS-5 scores decreased after treatment in each type of SOD patients,the difference were all statistically significant(P<0.05).After treatment,levels of ALT,AST,ALP,TBiL,and DBiL in biliary type SODⅠand typeⅡwere significantly lower than before(P<0.05);ALT,AST,ALP,GGT,and blood and urine amylase in patients with pancreatic type SOD after EST were significantly decreased than before(P<0.05),and the biochemical indicators of patients with SODⅢbefore and after treatment did not change significantly(P>0.05).After EST treatment,70(81.4%)of the 86 patients with bile type SOD showed significant effect,and 10 patients(11.6%)were effective,with an overall effective rate of 93.0%(80/86).Among the 16 patients with bile type SODⅠ,14 patients(87.5%)received significant effect,and 1 patient(6.3%)was effective,with an overall effective rate of 93.8%(15/16).That 51 patients with bile type SODⅡreceived EST,of which 43 patients(84.3%)were significantly effective and 6 patients(11.8%)were effective,with an overall response rate of 96.1%(49/51).Among the 19 patients with bile type SODⅢtreated with EST,13 patients(68.4%)were significantly effective and 3 patients(15.8%)were effective,with the overall effective rate was 84.2%(16/19).There was no statistically significant difference in the overall effective rate of patients with 3 types of biliary type SOD patients(P>0.05)
作者
任笠坤
李星志
刘浩
杨能红
曾文英
潘耀振
韩民
REN Likun;LI XINGzhi;LIU Hao;YANG Nenghong;ZENG Wenying;PAN Yaozhen;HAN Min(School of Clinical Medicine,Guizhou Medical University,Guiyang 5000,P.R.China;Department of Hepatobiliary Surgery,Afiliated Hospital of Guizhou Medical University,Guiyang 50000,P.R.China;Department of Hepatobiliary Surgery,Tumor Hospital Afiliated to Guizhou Medical Universit,Guiyang 50000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2020年第12期1515-1521,共7页
Chinese Journal of Bases and Clinics In General Surgery
