• 貴陽醫(yī)學(xué)院附屬醫(yī)院肝膽外科(貴州貴陽 550004);

目的探討內(nèi)鏡下十二指腸乳頭括約肌切開術(shù)(EST)對(duì)Oddi括約肌功能障礙(SOD)的治療價(jià)值。方法回顧性總結(jié)我院2005年8月至2009年5月期間按照Rome Ⅱ診斷標(biāo)準(zhǔn)篩選的42例SOD患者，B超、CT和MRCP排除膽管殘留結(jié)石、腫瘤或其他膽管及胰管梗阻病變，對(duì)確診為SOD的42例患者全部行EST。結(jié)果本組病例EST成功42例，成功率為100%。發(fā)生并發(fā)癥5例(11.90%)，均為急性胰腺炎，內(nèi)科保守治療3～7 d后痊愈; 無重癥急性胰腺炎發(fā)生，無消化道穿孔、出血、膽管炎等其他嚴(yán)重并發(fā)癥。隨訪12~45個(gè)月，平均23.8個(gè)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(fā)作返院行內(nèi)科治療痊愈。結(jié)論EST治療SOD由于療效確切、痛苦小、安全、并發(fā)癥少和可重復(fù)性，符合當(dāng)今微創(chuàng)外科治療的發(fā)展趨勢(shì)，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(nèi)鏡下十二指腸乳頭括約肌切開術(shù)治療Oddi括約肌功能障礙42例臨床分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(10): 1091-1094. doi: 復(fù)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(yùn)動(dòng)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(jì)宗正, 等. 膽囊切除術(shù)后奧狄括約肌功能障礙的內(nèi)鏡治療 [J]. 中華消化內(nèi)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(guó)現(xiàn)代手術(shù)學(xué)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(jīng)膽道鏡測(cè)壓觀察硝酸甘油等對(duì)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(yù)防ERCP術(shù)后胰腺炎及高淀粉酶血癥的臨床應(yīng)用研究 [J]. 中國(guó)普外基礎(chǔ)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(shù)式選擇與評(píng)價(jià) [J]. 醫(yī)師進(jìn)修雜志(外科版), 2004, 27(20): 5759.
21. 全卓勇, 彭開勤, 張應(yīng)天. Oddi括約肌切開成形術(shù)168例臨床分析.中國(guó)實(shí)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. 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. 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. 3. Hogan WJ, Geenen JE. Biliary dyskinesia [J]. Endoscopy, 1988, 20 Suppl 1: 179183.
  4. 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. 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. 6. 吳高松, 鄒聲泉. Oddi括約肌運(yùn)動(dòng)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. 7. 王永向, 吳濤, 紀(jì)宗正, 等. 膽囊切除術(shù)后奧狄括約肌功能障礙的內(nèi)鏡治療 [J]. 中華消化內(nèi)鏡雜志, 2002, 19(1): 2123.
  8. 8. 董家鴻, 冷建軍. Oddi括約肌功能障礙 [J]. 中國(guó)現(xiàn)代手術(shù)學(xué)雜志, 2002, 9(3): 164166.
  9. 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. 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. 11. 吳碩東, 金俊哲, 姜錫然, 等. 經(jīng)膽道鏡測(cè)壓觀察硝酸甘油等對(duì)Oddi括約肌的作用 [J]. 消化外科2002, 1(1): 4042.
  12. 12. Staritz M. Pharmacology of the sphincter of Oddi [J]. Endoscopy, 1988, 20 Suppl 1: 171174.
  13. 13. 劉雙, 劉軍, 孫文生, 等. 硝酸甘油預(yù)防ERCP術(shù)后胰腺炎及高淀粉酶血癥的臨床應(yīng)用研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(8): 641644.
  14. 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. 15. Németh AM. Somatostatin in the treatment of pancreatic diseases [J]. Orv Hetil, 2002, 143(19 Suppl): 10991108.
  16. 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. 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. 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. 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. 20. 楊維良, 張新晨. 十二指腸乳頭良性狹窄治療的術(shù)式選擇與評(píng)價(jià) [J]. 醫(yī)師進(jìn)修雜志(外科版), 2004, 27(20): 5759.
  21. 21. 全卓勇, 彭開勤, 張應(yīng)天. Oddi括約肌切開成形術(shù)168例臨床分析.中國(guó)實(shí)用外科雜志, 2002, 22(7): 411413.
  22. 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. 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.