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[缩窄性胆管炎:诊断与治疗。109例报告(作者译)]

[Stenosing odditis: diagnosis and treatment. Report of 109 cases (author's transl)].

作者信息

Lataste J, Guégan Y

出版信息

J Chir (Paris). 1977;114(5):317-28.

PMID:591595
Abstract

Stenosing odditis represents only 4.5 p. cent of all benign lesions of the extrahepatic bile ducts. Their diagnosis is made by peroperative radiomanometry, but clinically they are suggested by a past history and serious clinical signs. The pancreatic involvement is rarely macroscopic (10 p. cent of cases of which 5 p. cent are severe) and acute pancreatitis due to stricture of the sphincter without gall stones is exceptional. Associated biliary lesions are frequent; in 50 p. cent of cases, of lithiasis of the common bile duct or pancreatitis, in 66 p. cent of cases of residual odditis. The treatment is surgical. Sphincterotomy should be reserved for young subjects with a slightly dilated common bile duct, or when necessary to extract a gall stone from the lower end of the bile duct. Biliary by pass operations are all the more indicated when the patient is elderly or the common bile duct more dilated. Local complications are the most frequent and the most serious after sphincterotomy; the local complications of biliary by pass operations are usually very simple. The late results of biliary by-pass operations are better than those of sphincterotomy, which confirms that the pancreatic complications of odditis are rare or well tolerated. The presence of chronic pancreatitis in association is not an aggravating factor.

摘要

狭窄性胆管炎仅占肝外胆管所有良性病变的4.5%。其诊断通过术中胆管测压来进行,但临床上可根据既往病史和严重的临床体征作出提示。胰腺受累很少为肉眼可见(占病例的10%,其中5%为严重受累),因无胆结石的括约肌狭窄导致的急性胰腺炎很罕见。相关的胆道病变很常见;在50%的病例中伴有胆总管结石或胰腺炎,在66%的病例中伴有残余胆管炎。治疗为手术治疗。括约肌切开术应保留给胆总管轻度扩张的年轻患者,或在必要时从胆管下端取出胆结石。当患者年龄较大或胆总管扩张更明显时,更应行胆肠吻合术。括约肌切开术后局部并发症最常见且最严重;胆肠吻合术的局部并发症通常很简单。胆肠吻合术的远期效果优于括约肌切开术,这证实胆管炎的胰腺并发症很少见或耐受性良好。合并慢性胰腺炎并非加重因素。

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