十二指肠乳头括约肌切开术对Oddi括约肌功能的影响及与远期并发症的关系

目的探讨十二指肠乳头括约肌切开术（endoscopic sphincterotomy，EST）对Oddi括约肌功能的影响及与远期并发症的关系。方法收集2009年1月至2013年t月因胆总管结石行ERCP取石的患者，随访观察EST后并发症的发生情况，分为并发症组和对照组。在EST术前、术后1年分别采用Oddi括约肌测压术，对比Oddi括约肌基础压、收缩压高峰值的变化。并抽取胆汁，做细菌培养。结果共有68例患者纳入研究，随访13—36个月，有3例患者失访，远期并发症发生率为16．9％（11／65）。EST术后Oddi括约肌收缩高峰值和收缩频率明显低于术前，但并发症组与对照组之间在EST术前、术后差异均无统计学意义。EST术前并发症组胆道细菌阳性率54．5％（6／11）与对照组46．3％（25／54）之间比较差异无统计学意义（P=0．618），但术后胆道细菌阳性率明显高于对照组70％（7／10）比31．7％（13／41），P=0．026]。采用Logistic回归分析表明：合并胆囊结石、胆总管直径（〉1．5cm）、结石数量（〉3）、结石最大直径（〉20mm）、EST大切开是EST术后远期并发症的主要危险因素。结论EST术后远期并发症须加强关注，Oddi括约肌功能下降、存在胆肠反流是其发生的基础因素，同时也受多种危险因素的影响。

Effect of endoscopic sphincterotomy on function of sphincter of Oddi and long-term complications

Objective To investigate the effect of EST on function of sphincter of Oddi and on the long-term complications. Methods A total of 68 patients with common bile duct stones were recruited from January 2009 to January 2013 in The First People＇s Hospital of Hangzhou. All patients were under follow-up to observe the incidence of late complications after EST. Oddi sphincter manometry and bile bacterial culture were performed before EST and one year later. Results With the 13-36 months follow-up,the incidence of late complications was 16.9% （11/65）. The peak pressure and frequency of contraction of Oddi sphincter after EST were significantly lower than those before EST, but there were no significant differences between patients with complication and without （ P 〉 0. 05 ）. After EST, positive rate of biliary bacteria in patients with complications was much higher than that in patients without complications 70% （7/10）vs. 31.7% （13/41）, P = 0. 026], although there were no significant differences between them before EST 54. 5% （6/11 ） vs. 46. 3% （25/54） , P = 0. 618 ）. Logistic regression analysis showed that cholecystolithiasis, bile duct diameter （ 〉 1.5 cm）, number of stone （ 〉 3 ）, maximun diameter of stone （ 〉 20 mm）, large EST were independent risk factors for late complications of EST. Conclusion Importance should be attached to the late complications of EST with Oddi sphincter function declination, and biliary enteric reflux being the basic factor in late compilations after EST, which are also influenced by many risk factors.