Oddi括约肌压力测定及内镜下十二指肠乳头括约肌切开术对Oddi括约肌功能紊乱诊治的意义

Sphincter Oddi manometry and endoscopic sphincterotomy in diagnosis and treatment of patients with sphincter of Oddi dysfunction

摘要:

目的??针对反复右上腹痛的患者进行Oddi括约肌测压，以评价Oddi括约肌测压术（SOM）在慢性胆胰疾病诊治中的应用价值，并探讨内镜下十二指肠乳头切开术（EST）对Oddi括约肌基础压升高患者的疗效。方法?回顾分析该院2012年10月-2014年9月30例慢性上腹痛疑似Oddi括约肌功能紊乱（SOD）的患者在内镜逆行胰胆管造影术（ERCP）检查时接受SOM的临床资料，观察Oddi括约肌基础压、收缩幅度、频率和传播方式。对Oddi括约肌基础压>40.0 mmHg者及>30.0 mmHg并存在血淀粉酶、脂肪酶、谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（AKP）升高超过正常值2倍以上和（或）胆总管、胰管管增宽者行EST治疗，并随访其疗效。结果?30例患者SOM均存在不同程度的异常，Oddi括约肌基础压力为（36.6±21.1）mmHg，收缩幅度为（210.6±25.7）mmHg，收缩频率为（10.1±3.1）次/min，逆向收缩率为（55.0±8.0）%。30例患者均接受EST治疗，术后随访，其中27例（90.0%）有效。结论?SOM助于评价Oddi括约肌功能，对诊断SOD具有较大价值，测压发现Oddi括约肌基础压升高患者EST治疗可获得满意疗效。

Abstract:

Objective? To investigate the diagnostic value of endoscopic sphineter Oddi manometry (SOM) in patients with recurring abdominal pain and observe the value of endoscopic sphincterotomy (EST) in treatment of patients with sphincter of Oddi dysfunction (SOD).?Methods?Clinical data of 30 patients with chronic abdominal pain after cholecystectomy who were suspected SOD from 2012 October to 2014 September were collected and retrospectively analyzed. These patients received SOM in ERCP examination and the observation of Oddi sphincter basal pressure, contraction amplitude, frequency and mode of transmission were carried out. The EST were carried out in patients with basal pressure of Oddi sphincter higher than 40.0 mmHg or higher than 30.0 mmHg, and the presence of serum amylase, lipase, ALT, AST, AKP increased more than 2 times of the normal value and (or) of common bile duct, pancreatic duct widening.?Result?The SOM of all the 30 patients were all abnormal. The basal pressure of Oddi sphincter, the contraction amplitude, the contraction frequency and the reverse shrinkage were (36.6 ± 21.1) mmHg, (210.6 ± 25.7) mmHg, (10.1 ± 3.1) times/min and (55.0 ± 8.0)%. All the patients were treated with EST, of which 27 cases (90.0%) received good results.?Conclusion?SOM is helpful in evaluation of Oddisphincter function, it is of great value in diagnosis of SOD. EST treatment obtained satisfactory effect in patients with elevated basal pressure of Oddi sphincter.