肝胆胰外科杂志 ›› 2019, Vol. 31 ›› Issue (5): 301-309.doi: 10.11952/j.issn.1007-1954.2019.05.009

• 论著 临床研究 • 上一篇    下一篇

内镜下十二指肠乳头气囊扩张治疗胆总管结石对Oddi括约肌功能的影响

孔雷1,吴庆华1,陆一凡1,叶靳华1,赵良超1,徐敬慈2,黄丙仓1,邵明山1,李能平1    

  1. 上海交通大学医学院附属瑞金医院北院,上海   201821,1.普外科,2.放射科
  • 收稿日期:2018-09-28 出版日期:2019-05-22 发布日期:2019-05-22
  • 通讯作者: 李能平,主任医师,博士,E-mail:linengp@163.com
  • 作者简介:孔雷(1972-),男,山东济宁人,副主任医师,博士
  • 基金资助:
    上海市卫生和计划生育委员会科研课题(201740203)

Effect of endoscopic papillary balloon dilation for removing commom bile duct stones on the function of oddi sphincter 

KONG Lei1, WU Qing-hua2, LU Yi-fan1, YE Jin-hua1, ZHAO Liang-chao1, XU Jing-ci2, HUANG Bing-cang1, SHAO Ming-shan1, LI Neng-ping1.    

  1. 1Department of General Surgery, 2Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201821, China 
  • Received:2018-09-28 Online:2019-05-22 Published:2019-05-22

摘要:

目的 探讨内镜下十二指肠乳头气囊扩张(endoscopic papiallary balloon dilation,EPBD)治疗胆总管结石对Oddi括约肌功能的影响。方法 选择瑞金医院北院2010年5月至2014年5月因胆总管结石 入院行EPBD治疗并取净胆总管结石的患者共565例作为研究对象。根据EPBD所用气囊直径大小,将患者分成8 mm组(n=102)、 10 mm组(n=214)、 12 mm组(n=86)和 14 mm组(n=50),再前 2组归为小气囊 组,后2组归为大气囊组;同时将单纯行内镜下十二指肠乳头小切开(limited endoscopic sphincterotomy, LEST)的患者作为对照组(n=113)。对各组患者痊愈出院后每3个月进行一次电话、门诊随访,实验室检 查和影像学检查(上腹部CT、水溶性造影剂胃肠造影),每例患者随访至少1年,分析各组患者胆道积气、 胆总管反流、胆总管结石复发、反流性胆管炎的发生率。结果 各组胆道积气发生率均在EPBD术后3个 月时最高,随着气囊直径的增加而增加,特别是直径为14 mm的大气囊组,达到了58.7%,各组之间胆道 积气发生率有统计学差异(P<0.001)。但随着时间延长,各组胆道积气发生率逐渐降低,EPBD术后12个 月各组之间已无统计学差异(P>0.05)。93例在EPBD术后12个月时行水溶性造影剂胃肠造影,有7例(7.5%, 7/93)观察到了造影剂一过性反流至胆总管,持续约5 s到2 min,造影剂即返回至肠道,各组之间胆总管 反流无统计学差异(P>0.05)。 EPBD术后有15例胆总管结石复发,占2.7%。各组之间复发率无统计学差异 (P>0.05)。 10例有胆管炎的患者,均被证实为胆总管结石引起胆道梗阻所致,未发现无胆道梗阻的反流性 胆管炎患者。结论 与小气囊组相比,大气囊组术后早期可能对Oddi括约肌功能损害较大,但并未增加 因胆管反流造成的临床并发症。 

关键词: 内镜下十二指肠乳头气囊扩张, Oddi括约肌功能, 胆总管结石, 气囊直径

Abstract:

objective  To investigate the effect of endoscopic papillary balloon dilation (EPBD) for removing common bile duct (CBD) stones on the function of Oddi sphincter. Methods  A total of 565 patients with CBD stones treated by EPBD successfully between May 2010 and May 2014 were included in this study. According to the diameter of the balloon used in EPBD, patients were divided into 8 mm group (n=102), 10 mm group (n=214), 12 mm group (n=86) and 14 mm group (n=50). The former two groups were included in small balloon group, the latter two groups in big balloon group. At the same time, patients treated only with limited endoscopic sphincterotomy (LEST) were enrolled as control group (n=113). All patients discharged after hospitalization were followed-up every 3 months by telephone and outpatient checking such as laboratory examination and imaging examination (upper abdominal CT, water-soluble contrast gastrointestinal angiography). Each patient was followed-up for at least 1 year. The incidences of pneumobilia, common bile duct reflux, recurrence of common bile duct stones, and reflux cholangitis were analyzed. Results  The incidence of pneumobilia in each group achieved the peak at 3 months after EPBD, and increased with the increase of balloon diameter, particularly reached 58.7% in the 14 mm group, there was significant difference in the incidence of pneumobilia among 5 groups at 3 months after EPBD (P<0.001). However, with the prolongation of time (>3 months), the incidence of pneumobilia gradually decreased in all groups, especially in the large balloon groups; 12 months after EPBD, the difference among the groups was not statistically significant (P>0.05). 93 cases underwent water-soluble contrast gastrointestinal angiography at 12 months after EPBD, 7 cases (7.5%, 7/93) were observed with transient contrast reflux to middle and low segment of common bile duct, which only lasted about 5 seconds, and returned to the intestine. There was no significant difference among groups (P>0.05). There were 15 cases of recurrent common bile duct stones after EPBD (2.7%). There was no significant difference in recurrence rate among groups (P>0.05). Ten patients with cholangitis were confirmed, caused by biliary obstruction. There was no case of reflux cholangitis without biliary obstruction. Conclusion Compared with small balloon, large balloon has a greater damage to the Oddi sphincter function in the early postoperative period but which doesn't increase clinical complications caused by bile duct reflux.

Key words: endoscopic papillary balloon dilation (EPBD), function of sphincter Oddi, common bile duct stone, diameter of balloon

中图分类号: 

  • R657.4+
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