內鏡下十二指腸乳頭括約肌切開術治療Oddi括約肌功能障礙42例臨床分析_《中國普外基礎與臨床雜志》

作者：

韓民 , 孫誠誼 , 胡韻 , 李海洋

貴陽醫學院附屬醫院肝膽外科(貴州貴陽 550004);

關鍵詞：

內鏡下十二指腸乳頭括約肌切開術 Oddi括約肌功能障礙

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目的探討內鏡下十二指腸乳頭括約肌切開術(EST)對Oddi括約肌功能障礙(SOD)的治療價值。方法回顧性總結我院2005年8月至2009年5月期間按照Rome Ⅱ診斷標準篩選的42例SOD患者，B超、CT和MRCP排除膽管殘留結石、腫瘤或其他膽管及胰管梗阻病變，對確診為SOD的42例患者全部行EST。結果本組病例EST成功42例，成功率為100%。發生并發癥5例(11.90%)，均為急性胰腺炎，內科保守治療3～7 d后痊愈; 無重癥急性胰腺炎發生，無消化道穿孔、出血、膽管炎等其他嚴重并發癥。隨訪12~45個月，平均23.8個月，全部病例腹痛癥狀均明顯改善或緩解，有效率為100%，其中2例患者因高脂血癥性胰腺炎發作返院行內科治療痊愈。結論EST治療SOD由于療效確切、痛苦小、安全、并發癥少和可重復性，符合當今微創外科治療的發展趨勢，已成為SOD的首選治療方法。

引用本文： 韓民,孫誠誼,胡韻,李海洋. 內鏡下十二指腸乳頭括約肌切開術治療Oddi括約肌功能障礙42例臨床分析. 中國普外基礎與臨床雜志, 2011, 18(10): 1091-1094. doi: 復制

1.	Park SH, Watkins JL, Fogel EL, et al. Longterm outcome of endoscopic dual pancreatobiliary sphincterotomy in patients with manometrydocumented sphincter of Oddi dysfunction and normal pancreatogram [J]. Gastrointest Endosc, 2003, 57(4): 483491.
2.	Sugiyama M, Atomi Y. Followup of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients [J]. Br J Surg, 1998, 85(7): 917921.
3.	Hogan WJ, Geenen JE. Biliary dyskinesia [J]. Endoscopy, 1988, 20 Suppl 1: 179183.
4.	BarMeir S, Halpern Z, Bardan E, et al. Frequency of papillary dysfunction among cholecystectomized patients [J]. Hepatology, 1984, 4(2): 328330.
5.	Hawes RH, Tarnasky PR. Endoscopic manometry of the sphincter of Oddi: its usefulness for the diagnosis and treatment of benign papillary stenosis [J]. Gastrointest Endosc, 1996, 43(5): 536538.
6.	吳高松, 鄒聲泉. Oddi括約肌運動功能異常的診斷與治療 [J]. 中華肝膽外科雜志, 2003, 9(7): 442444.
7.	王永向, 吳濤, 紀宗正, 等. 膽囊切除術后奧狄括約肌功能障礙的內鏡治療 [J]. 中華消化內鏡雜志, 2002, 19(1): 2123.
8.	董家鴻, 冷建軍. Oddi括約肌功能障礙 [J]. 中國現代手術學雜志, 2002, 9(3): 164166.
9.	Frulloni L, Cavallini G. Acute recurrent pancreatitis and dysfunction of the sphincter of Oddi: comparison between invasive and noninvasive techniques [J]. JOP, 2001, 2(6): 406413.
10.	Testoni PA. Why the incidence of postERCP pancreatitis varies considerably? Factors affecting the diagnosis and the incidence of this complication [J]. JOP, 2002, 3(6): 195201.
11.	吳碩東, 金俊哲, 姜錫然, 等. 經膽道鏡測壓觀察硝酸甘油等對Oddi括約肌的作用 [J]. 消化外科2002, 1(1): 4042.
12.	Staritz M. Pharmacology of the sphincter of Oddi [J]. Endoscopy, 1988, 20 Suppl 1: 171174.
13.	劉雙, 劉軍, 孫文生, 等. 硝酸甘油預防ERCP術后胰腺炎及高淀粉酶血癥的臨床應用研究 [J]. 中國普外基礎與臨床雜志, 2009, 16(8): 641644.
14.	Lai KH, Lo GH, Cheng JS, et al. Effect of somatostatin on the sphincter of Oddi in patients with acute nonbiliary pancreatitis [J]. Gut, 2001, 49(6): 843846.
15.	Németh AM. Somatostatin in the treatment of pancreatic diseases [J]. Orv Hetil, 2002, 143(19 Suppl): 10991108.
16.	Prajapati DN, Hogan WJ. Sphincter of Oddi dysfunction and other functional biliary disorders: evaluation and treatment [J]. Gastroenterol Clin North Am, 2003, 32(2): 601618.
17.	Sugawa C, Park DH, Lucas CE, et al. Endoscopic sphincterotomy for stenosis of the sphincter of Oddi [J]. Surg Endosc, 2001, 15(9): 10041007.
18.	Wehrmann T, Aharonoff H, Dietrich CF, et al. Do ultrasound parameters allow diagnosis of biliary sphincter of Oddi dysfunction? [J]. Z Gastroenterol, 1997, 35(6): 449457.
19.	Geenen JE, Hogan WJ, Dodds WJ, et al. Intraluminal pressure recording from the human sphincter of Oddi [J]. Gastroenterology, 1980, 78(2): 317324.
20.	楊維良, 張新晨. 十二指腸乳頭良性狹窄治療的術式選擇與評價 [J]. 醫師進修雜志(外科版), 2004, 27(20): 5759.
21.	全卓勇, 彭開勤, 張應天. Oddi括約肌切開成形術168例臨床分析.中國實用外科雜志, 2002, 22(7): 411413.
22.	林擎天. 膽總管末端良性狹窄的診斷和治療 [J]. 中華普通外科雜志, 1999, 14(3): 208210.
23.	Barthet M, Lesavre N, Desjeux A, et al. Complications of endoscopic sphincterotomy: results from a single tertiary referral center [J]. Endoscopy, 2002, 34(12): 991997.

1. Park SH, Watkins JL, Fogel EL, et al. Longterm outcome of endoscopic dual pancreatobiliary sphincterotomy in patients with manometrydocumented sphincter of Oddi dysfunction and normal pancreatogram [J]. Gastrointest Endosc, 2003, 57(4): 483491.
2. Sugiyama M, Atomi Y. Followup of more than 10 years after endoscopic sphincterotomy for choledocholithiasis in young patients [J]. Br J Surg, 1998, 85(7): 917921.
3. Hogan WJ, Geenen JE. Biliary dyskinesia [J]. Endoscopy, 1988, 20 Suppl 1: 179183.
4. BarMeir S, Halpern Z, Bardan E, et al. Frequency of papillary dysfunction among cholecystectomized patients [J]. Hepatology, 1984, 4(2): 328330.
5. Hawes RH, Tarnasky PR. Endoscopic manometry of the sphincter of Oddi: its usefulness for the diagnosis and treatment of benign papillary stenosis [J]. Gastrointest Endosc, 1996, 43(5): 536538.
6. 吳高松, 鄒聲泉. Oddi括約肌運動功能異常的診斷與治療 [J]. 中華肝膽外科雜志, 2003, 9(7): 442444.
7. 王永向, 吳濤, 紀宗正, 等. 膽囊切除術后奧狄括約肌功能障礙的內鏡治療 [J]. 中華消化內鏡雜志, 2002, 19(1): 2123.
8. 董家鴻, 冷建軍. Oddi括約肌功能障礙 [J]. 中國現代手術學雜志, 2002, 9(3): 164166.
9. Frulloni L, Cavallini G. Acute recurrent pancreatitis and dysfunction of the sphincter of Oddi: comparison between invasive and noninvasive techniques [J]. JOP, 2001, 2(6): 406413.
10. Testoni PA. Why the incidence of postERCP pancreatitis varies considerably? Factors affecting the diagnosis and the incidence of this complication [J]. JOP, 2002, 3(6): 195201.
11. 吳碩東, 金俊哲, 姜錫然, 等. 經膽道鏡測壓觀察硝酸甘油等對Oddi括約肌的作用 [J]. 消化外科2002, 1(1): 4042.
12. Staritz M. Pharmacology of the sphincter of Oddi [J]. Endoscopy, 1988, 20 Suppl 1: 171174.
13. 劉雙, 劉軍, 孫文生, 等. 硝酸甘油預防ERCP術后胰腺炎及高淀粉酶血癥的臨床應用研究 [J]. 中國普外基礎與臨床雜志, 2009, 16(8): 641644.
14. Lai KH, Lo GH, Cheng JS, et al. Effect of somatostatin on the sphincter of Oddi in patients with acute nonbiliary pancreatitis [J]. Gut, 2001, 49(6): 843846.
15. Németh AM. Somatostatin in the treatment of pancreatic diseases [J]. Orv Hetil, 2002, 143(19 Suppl): 10991108.
16. Prajapati DN, Hogan WJ. Sphincter of Oddi dysfunction and other functional biliary disorders: evaluation and treatment [J]. Gastroenterol Clin North Am, 2003, 32(2): 601618.
17. Sugawa C, Park DH, Lucas CE, et al. Endoscopic sphincterotomy for stenosis of the sphincter of Oddi [J]. Surg Endosc, 2001, 15(9): 10041007.
18. Wehrmann T, Aharonoff H, Dietrich CF, et al. Do ultrasound parameters allow diagnosis of biliary sphincter of Oddi dysfunction? [J]. Z Gastroenterol, 1997, 35(6): 449457.
19. Geenen JE, Hogan WJ, Dodds WJ, et al. Intraluminal pressure recording from the human sphincter of Oddi [J]. Gastroenterology, 1980, 78(2): 317324.
20. 楊維良, 張新晨. 十二指腸乳頭良性狹窄治療的術式選擇與評價 [J]. 醫師進修雜志(外科版), 2004, 27(20): 5759.
21. 全卓勇, 彭開勤, 張應天. Oddi括約肌切開成形術168例臨床分析.中國實用外科雜志, 2002, 22(7): 411413.
22. 林擎天. 膽總管末端良性狹窄的診斷和治療 [J]. 中華普通外科雜志, 1999, 14(3): 208210.
23. Barthet M, Lesavre N, Desjeux A, et al. Complications of endoscopic sphincterotomy: results from a single tertiary referral center [J]. Endoscopy, 2002, 34(12): 991997.

《中國普外基礎與臨床雜志》

內鏡下十二指腸乳頭括約肌切開術治療Oddi括約肌功能障礙42例臨床分析

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《中國普外基礎與臨床雜志》

內鏡下十二指腸乳頭括約肌切開術治療Oddi括約肌功能障礙42例臨床分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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