CAJ | 학술논문

目的探讨胆石症与Oddi括约肌(SO)功能的关系.方法对已行外科胆总管探查术患者术后6周进行胆道镜经T管窦道胆道测压,项目包括SO基础压、SO收缩幅度、SO收缩频率、胆总管压力.探查术原因71例为胆石症,分为胆囊结石组(20例)、胆总管结石组(22例)和肝内胆管结石组(29例);9例因外伤,作为正常对照.胆道镜先明确有无胆道结石,如有结石在取石前后分别测压,如无结石则直接测压.结果胆道镜检查50例存在胆管结石者取石前后各测压指标均无统计学差异.胆囊结石组、胆总管结石组各指标与对照组无明显差异(P＞0.05);但肝内胆管结石组的SO基础压、SO收缩幅度、胆总管压力均较对照组明显降低[(8.92±5.87)mm Hg比(16.21±3.27)mm Hg、(58.89±26.40)mm Hg比(106.30±54.28)mm Hg、(8.49±6.89)mm Hg比(13.56±2.93)mm Hg],差异均有统计学意义(P＜0.05),SO收缩频率无统计学差异(P＞0.05).结论胆道测压不能作为判断胆管内有无结石的可靠依据;肝内胆管结石患者存在SO功能异常,其SO基础压和收缩幅度、胆总管压力均明显下降.
목적 탐토담석증여Oddi괄약기(SO)공능적관계.방법 대이행외과담총관탐사술환자술후6주진행담도경경T관두도담도측압,항목포괄SO기출압、SO수축폭도、SO수축빈솔、담총관압력.탐사술원인71례위담석증,분위담낭결석조(20례)、담총관결석조(22례)화간내담관결석조(29례);9례인외상,작위정상대조.담도경선명학유무담도결석,여유결석재취석전후분별측압,여무결석칙직접측압.결과 담도경검사50례존재담관결석자취석전후각측압지표균무통계학차이.담낭결석조、담총관결석조각지표여대조조무명현차이(P＞0.05);단간내담관결석조적SO기출압、SO수축폭도、담총관압력균교대조조명현강저[(8.92±5.87)mm Hg비(16.21±3.27)mm Hg、(58.89±26.40)mm Hg비(106.30±54.28)mm Hg、(8.49±6.89)mm Hg비(13.56±2.93)mm Hg],차이균유통계학의의(P＜0.05),SO수축빈솔무통계학차이(P＞0.05).결론 담도측압불능작위판단담관내유무결석적가고의거;간내담관결석환자존재SO공능이상,기SO기출압화수축폭도、담총관압력균명현하강.
Objective To explore the relationship between cholelithiasis and the function of sphincter of Oddi (SO). Methods To identify the existence of calculi, choledochoscopy was performed in patients 6 weeks after exploration of the common bile duct (CBD) and T tube drainage, in which 71 were patients with stones in gall bladder, CBD or intra-hepatic bile duct, and 9 with trauma of pancreas or liver.Biliary manometry was performed after choledochoscopy, and an additional manometry was applied after calculus removal if calculi were detected. The indices measured included SO basal pressure ( SOBP), amplitude of SO contractions (SOCA), frequency of SO contractions (SOF) and CBD pressure (CBDP). The patients with cholelithiasis were classified into cholecystolithiasis group, choledocholithiasis group, and hepatolithiasis group according to the position of calculi. Patients with trauma were assigned as the control group.Results All variables in 50 patients with choledocholithiasis were similar before and after the procedure.The variables in patients with cholecystolithiasis and choledocholithiasis had no difference from those of the control (P ＞ 0. 05 ). The SOBP and SOCA of patients in hepatolithiasis group were lower than those of the control group ( P ＜ 0. 05 ), while no difference in SOF was detected (P ＞ 0. 05 ). Conclusion The function of SO in patients with hepatolithiasis is abnormal ( decrease in SOBP and SOCA). Biliary manometry cannot be the reliable evidence for the existence of calculi in bile duct.