十二指肠镜下诊断和治疗胆囊切除术后胆道型Oddi括约肌功能障碍

目的探讨十二指肠镜技术对胆囊切除术后胆道型Oddi括约肌功能障碍(sphincter of Oddi dysfunction,SOD)的诊断和治疗价值。方法参考SOD国际诊断标准(罗马Ⅱ),选择符合胆道型SOD标准的46例行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP),其内镜诊断特点和X线影像表现符合胆道型SOD诊断标准的病例,直接行内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)或内镜下乳头气囊扩张术(endoscopic papillary ballooncatheterdilatation,EPBD)治疗。结果ERCP显示46例胆总管直径1.3~2.5cm,胆管无结石及其他器质性病变,下端呈鸟嘴状狭窄或渐进性狭窄28例。39例行EST,7例行EPBD。34例(73.9%)腹痛基本消失,8例(17.4%)明显缓解,4例(8.7%)无明显改善,总有效率91.3%(42/46)。术后1~14d发热及黄疸者症状完全消失,术后7~14d肝功能酶学异常指标均恢复正常。2例术后发生急性胰腺炎,经禁食、抗炎治疗后治愈,无其他严重并发症发生。46例随访1~36个月,平均10.8月,治疗后症状改善或消失,未见复发及其他异常。结论对于胆囊切除术后胆道型SOD,内镜下诊断和治疗技术是一种微创、安全、有效的措施。

Duodenoscopy for the Diagnosis and Therapy of Biliary Type Sphincter of Oddi Dysfunction after Cholecystectomy

Objective To investigate the value of dudenoscopy for the diagnosis and treatment of biliary type Sphincter of Oddi dysfunction（SOD）after cholecystectomy.Methods According to the diagnostic criteria for SOD（Rome Ⅱ）,46 cases who were diagnosed by endoscopic retrograde cholangiopancreatography（ERCP）,endoscopy or X-ray imaging,were enrolled in this study.Endoscopic sphincterotomy（EST）or endoscopic papillary balloon catheterdilatation（EPBD）were used immediately to treat the patients.Results ERCP showed a dilated common bile duct（1.3-2.5 cm）in all the cases.No stones or organic diseases were found.Beak form narrow and gradual narrow in the inferior bile duct could be seen in 28 cases.In our cases,EST was performed in 39 patients,while EPBD was employed in 7.After the treatments,abdominal pain disappeared in 34 cases（73.9%）,improved in 8 cases（17.4%）,and no improvement in 4 cases（8.7%）.The total effective rate of the treatments was 91.3%（4246）.After the surgery,fever and jaundice disappeared in all the patients in 1 to 14 days,and the elevated liver enzymes reverted to a normal ranged in 7 to 14 days.Two patients developed postoperative acute pancreatitis and was then cured by fasting and anti-inflammatory therapy.No other serious complication occurred in this series.All the patients were followed up for 1 months to 3.0 years（mean,10.8 months）,during which no recurrence or other abnormalities were found.Conclusions ERCP,EST and EPBD are minimally invasive,effective,and safe for diagnosis and treatment of biliary type of sphincter of Oddi dysfunction after cholecystectomy.