Wu Shuo-dong, Yu Hong, Wang Hao-lin, Su Yang, Zhang Zhen-hai, Sun Shao-long, Kong Jing, Tian Yu, Tian Zhong, Wei Yi, Jin Hong-xu, Jin Jun-zhe
Department of the Second General Surgery, the Second Hospital of China Medical University, Shenyang 110004, China.
Zhonghua Wai Ke Za Zhi. 2007 Jan 1;45(1):58-61.
To investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of bile duct pigment gallstone.
One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of (99m)Tc-DTPA in the bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal pressure of Oddi's sphincter (SOBP), amplitude of Oddi's sphincter (SOCA), frequency of contraction (SOF), duration of contraction (SOD), duodenal pressure (DP), common bile duct pressure (CBDP) were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with bile duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones, patients with bile duct stone and gallbladder stones, patients with bile duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope.
Of the patients, 44 were detected with duodenal-biliary reflux (35.8%). SOBP, SOCA and CBDP in the reflux group were much lower than those in control group (P < 0.001). The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group (P < 0.01). Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in patients with bile duct pigment stone was 36.62%, which was higher than that of the other 3 groups. The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stone was higher than that of patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla and patients with bile duct stones originating from the gallbladder.
The patients with bile duct pigment stone have apparent duodenal-biliary reflux and infection of the bile duct. The state of structure and function of Oddi's sphincter is correlated significantly with bile duct pigment stone. The anatomic abnormalities and malfunction of Oddi's sphincter played an important role in the formation of bile duct pigment stone.
探讨Oddi括约肌解剖异常与功能障碍和胆管色素结石形成之间的关系。
对123例行胆囊切除及胆总管切开取石术后留置T管的患者，通过检测胆汁中（99m）Tc-DTPA放射性计数分为反流组和对照组。其中随机选取53例患者行胆总管镜测压，记录Oddi括约肌基础压力（SOBP）、Oddi括约肌振幅（SOCA）、收缩频率（SOF）、收缩持续时间（SOD）、十二指肠压力（DP）、胆总管压力（CBDP）并进行评分分析。采用放射免疫法测定45例患者及12名健康志愿者的血浆胃动素水平和血清胃泌素水平。通过钡餐检查研究胆管色素结石患者、无消化道疾病患者、胆囊息肉患者、胆囊结石患者十二指肠降部憩室的发生率。通过十二指肠镜检测原发性胆管色素结石患者、胆管结石合并胆囊结石患者、胆囊源性胆管结石患者、胆管末端及乳头炎伴狭窄患者、胆管末端及乳头癌患者、胆囊切除术后综合征患者十二指肠壶腹周围憩室的发生率。
患者中44例检测出十二指肠-胆管反流（35.8%）。反流组的SOBP、SOCA及CBDP均明显低于对照组（P<0.001）。反流组血清胃泌素水平和血浆胃动素水平均明显低于对照组（P<0.01）。胃动素水平与SOBP呈正相关，胃泌素水平与SOBP及CBDP呈正相关。胆管色素结石患者十二指肠憩室发生率为36.62%，高于其他3组。原发性胆管色素结石患者十二指肠壶腹周围憩室发生率高于胆管末端及乳头炎伴狭窄患者、胆管末端及乳头癌患者、胆囊源性胆管结石患者。
胆管色素结石患者存在明显的十二指肠-胆管反流及胆管感染。Oddi括约肌的结构和功能状态与胆管色素结石显著相关。Oddi括约肌的解剖异常及功能障碍在胆管色素结石形成中起重要作用。
