Oddi 括约肌功能保存是否能预防内镜乳头球囊扩张术后患者胆总管结石复发?
Does preserved sphincter of Oddi function prevent common bile duct stones recurrence in patients after endoscopic papillary balloon dilation?
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan, ROC; Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan, ROC; College of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2018 Apr;81(4):311-315. doi: 10.1016/j.jcma.2018.01.007. Epub 2018 Mar 1.
BACKGROUND
Whether preserving sphincter of Oddi (SO) function by endoscopic papillary balloon dilation (EPBD) is beneficial for preventing recurrent common bile duct stone disease (CBDS) is controversial. The aim of this study was to measure sphincter of Oddi (SO) function by using SO manometry, and to evaluate the association with recurrent CBDS.
METHODS
Patients with suspected CBDS who underwent successful EPBD were included. These patients underwent SO manometry at two months after EPBD with bile duct clearance. They were regularly followed for recurrent CBDS.
RESULTS
From January 2000 to December 2009, 185 patients received EPBD and SO manometry was included. There were 64% male with mean age of 65 ± 15.6 years. Mean ballooning inflation size was 1.1 ± 0.19 cm and mean ballooning time was 4.5 ± 0.85 min 55.7% had a sphincter of Oddi basal pressure (SOBP) of 0 mmHg, 16.2% < 10 mmHg, 26.5% 10-40 mmHg, and 1.6% > 40 mmHg. In multivariate analysis, EPBD with balloon ≥1.2 cm was the only factor for loss of SO function. Moreover, patients with preserved SO function had higher stone recurrence rate (15% vs. 5%, p = 0.034).
CONCLUSION
EPBD using balloon ≥1.2 cm is a major factor for loss of SO function, which seems to reduce the risk of recurrent CBD stones.
背景
通过内镜乳头球囊扩张术（EPBD）保留Oddi 括约肌（SO）功能是否有利于预防复发性胆总管结石病（CBDS）存在争议。本研究旨在通过 SO 测压法测量 SO 功能，并评估其与复发性 CBDS 的相关性。
方法
纳入接受成功 EPBD 治疗且胆总管结石清除的疑似 CBDS 患者。这些患者在 EPBD 后两个月行 SO 测压，同时进行胆管清除。对患者进行定期随访，以了解 CBDS 的复发情况。
结果
2000 年 1 月至 2009 年 12 月，共有 185 例患者接受 EPBD 治疗，纳入 SO 测压，其中男性占 64%，平均年龄为 65±15.6 岁。球囊充气扩张大小平均为 1.1±0.19cm，球囊充气时间平均为 4.5±0.85min。55.7%的患者 SO 基础压（SOBP）为 0mmHg，16.2%<10mmHg，26.5%为 10-40mmHg，1.6%>40mmHg。多因素分析显示，球囊直径≥1.2cm 的 EPBD 是 SO 功能丧失的唯一因素。此外，保留 SO 功能的患者结石复发率更高（15%比 5%，p=0.034）。
结论
直径≥1.2cm 的球囊 EPBD 是 SO 功能丧失的主要因素，似乎降低了复发性 CBD 结石的风险。
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