Błaut U, Marecik J, Thor P J
Katedra Patofizjologii, Collegium Medicum UJ, Kraków.
Folia Med Cracov. 1999;40(3-4):93-105.
Choledocholithiasis is often found in patients after cholecystectomy done previously for cholelithiasis.
To evaluate the effects of cholecystectomy and common bile stones' presence on sphincter of Oddi (SO) motility.
13 patients with common bile duct stones (2 men and 11 women, age 54 to 85 yrs) were studied. They were divided in two groups: A--6 pts age 54 to 85 yrs (with biliary lithiasis) and group B of 7 pts age 55-71 after cholecystectomy. Cholecystectomized group was further divided into 2 groups according to administration (B1 group) or not (B2) a premedication.
Sphincter of Oddi manometry was done in all patients as the part of routine ERCP. A water-perfused, low-compliance, triple-lumen manometric system (Synectics Medical Sweden) was used to record the SO tonic and phasic activity. Common bile duct (CBD) pressure, basal SO pressure, SO phasic contractions frequency, duration and amplitude as well as direction of propagation peristaltic waves, motility index (MI) and AuC (area under curve) were measured.
The CBD pressure, the basal SO pressure and the frequency of phasic SO waves tended to be lower in patients after cholecystectomy (p > 0.05). We observed profound changes in the motility pattern of SO phasic activity. There was significantly less anterograde and more retrograde waves in patients from group B than A (18.9% vs. 68.8%; p < 0.01 and 52.4% vs. 10.4% respectively; p = 0.01). In the group B1 comparing with group B2 we found significant decrease of frequency (1.8/min +/- 0.53 vs. 3.3/min +/- 0.77; p < 0.05) and increase of the mean amplitude of phasic SO activity (223.2 mmHg +/- 22.9 vs. 137.3 mmHg +/- 25.0; p < 0.01). The duration of pressure waves was prolonged (with long "plateau" or multipeaked) with rapid pressure increase, what resulted in high AuC index (1155.61 +/- 100.42 vs. 515.23 +/- 210.9; p < 0.01). However no difference in MI was observed.
Our results confirm hypothesis that cholecystectomy influences the pattern of phasic SO motility. Moreover increased percent of retrograde propagation of SO phasic contractions probably contributes to subsequent common duct stones development rather than being the consequences of their presence.
胆总管结石常见于既往因胆结石行胆囊切除术的患者。
评估胆囊切除术及胆总管结石的存在对Oddi括约肌（SO）运动功能的影响。
研究了13例胆总管结石患者（2例男性，11例女性，年龄54至85岁）。他们被分为两组：A组——6例年龄54至85岁（患有胆石症）；B组——7例年龄55 - 71岁，已行胆囊切除术。已行胆囊切除术的组根据是否给予术前用药进一步分为两组（B1组）或未用药组（B2组）。
所有患者均进行Oddi括约肌测压，作为常规内镜逆行胰胆管造影（ERCP）的一部分。使用水灌注、低顺应性、三腔测压系统（瑞典Synectics Medical公司）记录SO的张力和相位活动。测量胆总管（CBD）压力、基础SO压力、SO相位收缩频率、持续时间、幅度以及蠕动波传播方向、运动指数（MI）和曲线下面积（AuC）。
胆囊切除术后患者的CBD压力、基础SO压力和相位SO波频率趋于降低（p>0.05）。我们观察到SO相位活动的运动模式有深刻变化。B组患者的顺行波明显少于A组，逆行波明显多于A组（分别为18.9%对68.8%；p<0.01和52.4%对10.4%；p = 0.01）。与B2组相比，B1组的频率显著降低（1.8次/分钟±0.53对3.3次/分钟±0.77；p<0.05），SO相位活动的平均幅度增加（223.2 mmHg±22.9对137.3 mmHg±25.0；p<0.01）。压力波持续时间延长（有长“平台期”或多峰），压力快速升高，导致AuC指数升高（1155.61±100.42对515.23±210.9；p<0.01）。然而，未观察到MI有差异。
我们的结果证实了胆囊切除术会影响SO相位运动模式的假设。此外，SO相位收缩逆行传播百分比的增加可能促成随后胆总管结石的形成，而非其存在的后果。
