Oddi括约肌(sphincter of Oddi)是机体内一个复杂而精细调节的结构,它是由围绕于胆总管末段、胰管末段及胆胰管汇合Vater壶腹的三部分肌束组成。近年来,随着对Oddi括约肌的解剖结构与生理功能研究的不断深入,人们已认识到Oddi括约肌在...Oddi括约肌(sphincter of Oddi)是机体内一个复杂而精细调节的结构,它是由围绕于胆总管末段、胰管末段及胆胰管汇合Vater壶腹的三部分肌束组成。近年来,随着对Oddi括约肌的解剖结构与生理功能研究的不断深入,人们已认识到Oddi括约肌在维护胆道系统与胰管系统的正常压力、胆汁与胰液的流体力学、胆道与胰管系统的无菌状态以及阻止十二指肠液反流等方面均具有不可替代的关键作用;其结构与功能的受损或被废弃可导致一系列胆胰疾病的发生。因此,当代胆道外科医生应该充分认识到保护Oddi括约肌的重要性。展开更多
The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pat...The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pathophysiology,morbidity,mortality and prevention of post-ERCP pancreatitis(PEP) in adult patients using the PubMed database.Search terms included endoscopic retrograde cholangiopancreatography,pancreatitis,ampulla of vater,endoscopic sphincterotomy,balloon dilatation,cholangiography,adverse events,standards and utilization.We limited our review of articles to those published between January 1,1994 and August 15,2009 regarding human adults and written in the English language.Publicat ions from the reference sections were reviewed and included if they were salient and fell into the time period of interest.Between the dates queried,seventeen large(> 500 patients) prospective and four large retrospective trials were conducted.PEP occurred in 1-15 in the prospective trials and in 1-4 in the retrospective trials.PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis.Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last f ifteen years in 63 trials.Although 22 of 63 trials published during our period of review suggested a reduction in PEP,no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP.In conclusion,PEP is a well-recognized complication of ERCP.Medical treatment for prevention has been disappointing.Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials.展开更多
目的探索能准确稳定记录犬Oddi括约肌(sphincter of Oddi,SO)肌电活动的新方法,并对记录到的肌电波形进行初步分析。方法用自行研制的黏膜接触式电极记录30只犬SO肌电活动,同时记录十二指肠和胃的肌电活动,分析SO肌电波形的规律以及和...目的探索能准确稳定记录犬Oddi括约肌(sphincter of Oddi,SO)肌电活动的新方法,并对记录到的肌电波形进行初步分析。方法用自行研制的黏膜接触式电极记录30只犬SO肌电活动,同时记录十二指肠和胃的肌电活动,分析SO肌电波形的规律以及和胃十二指肠肌电的关系。结果用我们的方法可以记录到犬SO的快波和慢波,同步记录以及切离实验证实记录到的波形是犬的SO肌电而不是来自十二指肠和胃。结论犬的SO肌电记录是可行的,犬SO快波和慢波的发现将对SO功能研究提供一个新的平台。展开更多
BACKGROUND: The presence of intraduodenal periampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China ...BACKGROUND: The presence of intraduodenal periampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal periampullary diverticulum and biliary disease, especially the formation of bile duct pigment stones. METHODS: A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy (EST) were studied retrospectively. They were divided into 6 groups according to the category of biliary disease, and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones. RESULTS: There were 44 patients with intraduodenal periampullary diverticulum in 81 patients with primary bile duct pigment stones (54.32%), 4 in 8 patients with bile duct stones and gallbladder stones (50%), 7 in 33 patients with bile duct stones secondary to gallbladder stones (21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla (14.29%), 1 in 22 patients with carcinoma of the end of the bile duct and papilla (4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction (38.46%). CONCLUSIONS: The incidence rate of intraduodenal periampullary diverticulum in patients with primary bile duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation 展开更多
AIM: To investigate the mechanisms and effects of sphincter of Oddi(SO) motility on cholesterol gallbladder stone formation in guinea pigs.METHODS: Thirty-four adult male Hartley guinea pigs were divided randomly into...AIM: To investigate the mechanisms and effects of sphincter of Oddi(SO) motility on cholesterol gallbladder stone formation in guinea pigs.METHODS: Thirty-four adult male Hartley guinea pigs were divided randomly into two groups, the control group(n = 10) and the cholesterol gallstone group(n = 24), which was sequentially divided into four subgroups with six guinea pigs each according to time of sacrifice. The guinea pigs in the cholesterol gallstone group were fed a cholesterol lithogenic diet and sacrificed after 3, 6, 9, and 12 wk. SO manometry and recording of myoelectric activity were obtained by a multifunctional physiograph at each stage. Cholecystokinin-A receptor(CCKAR) expression levels in SO smooth muscle were detected by quantitative real-time PCR(q RT-PCR) and serum vasoactive intestinal peptide(VIP), gastrin, and cholecystokinin octapeptide(CCK-8) were detected by enzyme-linked immunosorbent assay at each stage in the process of cholesterol gallstone formation.RESULTS: The gallstone formation rate was 0%, 0%, 16.7%, and 83.3% in the 3, 6, 9, and 12 wk groups, respectively. The frequency of myoelectric activity in the 9 wk group, the amplitude of myoelectric activity in the 9 and 12 wk groups, and the amplitude and the frequency of SO in the 9 wk group were all significantly decreased compared to the control group. The SO basal pressure and common bile duct pressure increased markedly in the 12 wk group, and the CCKAR expression levels increased in the 6 and 12 wk groups compared to the control group. Serum VIP was elevated significantly in the 9 and 12 wk groups and gastrin decreased significantly in the 3 and 9 wk groups. There was no difference in serum CCK-8 between the groups.CONCLUSION: A cholesterol gallstone-causing diet can induce SO dysfunction. The increasing tension of the SO along with its decreasing activity may play an important role in cholesterol gallstone formation. Expression changes of CCKAR in SO smooth muscle and serum VIP and CCK-8 may be important causes of SO dysfunction.展开更多
文摘Oddi括约肌(sphincter of Oddi)是机体内一个复杂而精细调节的结构,它是由围绕于胆总管末段、胰管末段及胆胰管汇合Vater壶腹的三部分肌束组成。近年来,随着对Oddi括约肌的解剖结构与生理功能研究的不断深入,人们已认识到Oddi括约肌在维护胆道系统与胰管系统的正常压力、胆汁与胰液的流体力学、胆道与胰管系统的无菌状态以及阻止十二指肠液反流等方面均具有不可替代的关键作用;其结构与功能的受损或被废弃可导致一系列胆胰疾病的发生。因此,当代胆道外科医生应该充分认识到保护Oddi括约肌的重要性。
文摘The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pathophysiology,morbidity,mortality and prevention of post-ERCP pancreatitis(PEP) in adult patients using the PubMed database.Search terms included endoscopic retrograde cholangiopancreatography,pancreatitis,ampulla of vater,endoscopic sphincterotomy,balloon dilatation,cholangiography,adverse events,standards and utilization.We limited our review of articles to those published between January 1,1994 and August 15,2009 regarding human adults and written in the English language.Publicat ions from the reference sections were reviewed and included if they were salient and fell into the time period of interest.Between the dates queried,seventeen large(> 500 patients) prospective and four large retrospective trials were conducted.PEP occurred in 1-15 in the prospective trials and in 1-4 in the retrospective trials.PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis.Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last f ifteen years in 63 trials.Although 22 of 63 trials published during our period of review suggested a reduction in PEP,no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP.In conclusion,PEP is a well-recognized complication of ERCP.Medical treatment for prevention has been disappointing.Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials.
文摘目的探索能准确稳定记录犬Oddi括约肌(sphincter of Oddi,SO)肌电活动的新方法,并对记录到的肌电波形进行初步分析。方法用自行研制的黏膜接触式电极记录30只犬SO肌电活动,同时记录十二指肠和胃的肌电活动,分析SO肌电波形的规律以及和胃十二指肠肌电的关系。结果用我们的方法可以记录到犬SO的快波和慢波,同步记录以及切离实验证实记录到的波形是犬的SO肌电而不是来自十二指肠和胃。结论犬的SO肌电记录是可行的,犬SO快波和慢波的发现将对SO功能研究提供一个新的平台。
文摘BACKGROUND: The presence of intraduodenal periampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal periampullary diverticulum and biliary disease, especially the formation of bile duct pigment stones. METHODS: A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy (EST) were studied retrospectively. They were divided into 6 groups according to the category of biliary disease, and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones. RESULTS: There were 44 patients with intraduodenal periampullary diverticulum in 81 patients with primary bile duct pigment stones (54.32%), 4 in 8 patients with bile duct stones and gallbladder stones (50%), 7 in 33 patients with bile duct stones secondary to gallbladder stones (21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla (14.29%), 1 in 22 patients with carcinoma of the end of the bile duct and papilla (4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction (38.46%). CONCLUSIONS: The incidence rate of intraduodenal periampullary diverticulum in patients with primary bile duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation
基金Supported by Natural Science Foundation of Shandong Province,China,No.ZR 2012 HM-079
文摘AIM: To investigate the mechanisms and effects of sphincter of Oddi(SO) motility on cholesterol gallbladder stone formation in guinea pigs.METHODS: Thirty-four adult male Hartley guinea pigs were divided randomly into two groups, the control group(n = 10) and the cholesterol gallstone group(n = 24), which was sequentially divided into four subgroups with six guinea pigs each according to time of sacrifice. The guinea pigs in the cholesterol gallstone group were fed a cholesterol lithogenic diet and sacrificed after 3, 6, 9, and 12 wk. SO manometry and recording of myoelectric activity were obtained by a multifunctional physiograph at each stage. Cholecystokinin-A receptor(CCKAR) expression levels in SO smooth muscle were detected by quantitative real-time PCR(q RT-PCR) and serum vasoactive intestinal peptide(VIP), gastrin, and cholecystokinin octapeptide(CCK-8) were detected by enzyme-linked immunosorbent assay at each stage in the process of cholesterol gallstone formation.RESULTS: The gallstone formation rate was 0%, 0%, 16.7%, and 83.3% in the 3, 6, 9, and 12 wk groups, respectively. The frequency of myoelectric activity in the 9 wk group, the amplitude of myoelectric activity in the 9 and 12 wk groups, and the amplitude and the frequency of SO in the 9 wk group were all significantly decreased compared to the control group. The SO basal pressure and common bile duct pressure increased markedly in the 12 wk group, and the CCKAR expression levels increased in the 6 and 12 wk groups compared to the control group. Serum VIP was elevated significantly in the 9 and 12 wk groups and gastrin decreased significantly in the 3 and 9 wk groups. There was no difference in serum CCK-8 between the groups.CONCLUSION: A cholesterol gallstone-causing diet can induce SO dysfunction. The increasing tension of the SO along with its decreasing activity may play an important role in cholesterol gallstone formation. Expression changes of CCKAR in SO smooth muscle and serum VIP and CCK-8 may be important causes of SO dysfunction.
