清醒状态下兔Oddi括约肌肌电活动检测模型的建立

目的：建立清醒状态兔Oddi括约肌（SO）肌电检测的动物模型,研究其肌电活动特征。方法：将成年家兔麻醉后,于胆囊底部置管一根;将十二指肠大乳头对系膜缘与间置的空肠袢远端吻合,空肠袢关闭后与胆囊内置管分别埋置于皮下,恢复14d后用环状电极进行清醒状态下SO肌电检测。对其消化间期、进食后、外源性胆囊收缩素（CCK）泵注下SO肌电幅值、频率及每分钟运动指数进行分析。结果：利用该模型可以在清醒状态下稳定记录到SO肌电活动,表现为慢波恒定基础上快波的周期性变化,进食后SO的快波增强,外源性CCK对兔SO的肌电有兴奋作用。结论：清醒状态下SO肌电活动检测更能反映括约肌的功能状态,这为今后研究病理状态下SO的活动提供了技术平台。     

跨越壶腹部支架对犬胆道压力和Oddi括约肌病理学影响的实验研究

目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制.材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周后十二指肠压(duodenal pressure,DP)、SO基础压(sphincter of Oddi basal pressure,SOBP)、收缩幅度(sphincter of Oddi contractive amplitude,SOCA)、收缩间期(sphincter of Oddi duration,SOD)以及胆总管压(common bile duct pressure,CBDP)的变化.同时,应用胶原纤维染色观察支架置入后SO的病理变化.对实验所获得的计量资料采用配对t检验进行比较,P<0.05为差异有统计学意义.结果:以DP作为零点,获得其他各项指标的相对值结果.支架置入前SOBP、SOCA、SOD、CBDP分别为:13.69±4.29mmHg、42.65±8.50mmHg、6.69±1.46s、12.98±2.86mmHg;支架置入5周后分别为:10.58±3.98mmHg、31.95±9.00mmHg、4.47±1.21s、7.43±2.20mmHg,其中SOCA较支架置入前降低,SOD相比支架置入前缩短,两者的差异均有统计学意义(P<0.05).而CBDP明显低于支架置入前,差异具有统计学意义(P<0.05).支架置入5周后,壶腹部SO肌层中发生了不同程度的纤维化、腺体病变和炎性反应等病理变化.结论:跨越壶腹部植入支架5周后,SO运动功能的减弱以紧张性收缩的减弱为主,而基础性收缩仍然存在.CBDP虽然下降,但仍高于正常的DP,并保持与之的压力梯度,从而为抑制肠胆反流提供了可能.而壶腹部SO肌层中则发生了不同程度的纤维化、腺体病变和炎性反应等病理变化.     

不同术式内镜逆行胰胆管造影术对Oddi括约肌功能的影响研究进展

Oddi括约肌是控制胆胰管通道的重要阀门,其损伤会造成肠胆反流,引起反流性胆管炎、胆囊炎、结石再发,以及胆管癌等一系列远期并发症。胆总管结石作为临床最常见的消化系统疾病之一,近年来发病率逐渐增高。内镜逆行胰胆管造影术(ERCP)是治疗胆总管结石的首选微创方法,已广泛应用于临床,但其可能对Oddi括约肌造成损伤。本文对ERCP的几种主要术式(内镜下乳头括约肌切开术、内镜下十二指肠乳头气囊扩张术、内镜下乳头括约肌小切开联合气囊扩张术、内镜下钛夹乳头成形术)对Oddi括约肌功能的影响进行综述。     

体表检测兔膀胱肌电活动的实验研究

目的探讨体表检测膀胱平滑肌电活动的方法，评估其体表肌电是否可以反映膀胱壁平滑肌电及其收缩活动，为膀胱的功能活动探索一种无创的检测方法。方法利用体表电极、膀胱壁直接电极、压力传感器，分别同步记录兔膀胱的体表肌电、膀胱壁平滑肌电和膀胱内压力信号，对它们进行相关性分析。结果贮尿期膀胱直接电极和体表电极均未记录到明显的电信号（脉冲串），膀胱内压也无明显变化；而排尿期它们均可同时记录到脉冲串并伴有明显的膀胱内压变化。体表膀胱肌电与膀胱壁平滑肌电、膀胱内压之间的相关系数分别是r=-0．8018和r=-0．8082：膀胱壁平滑肌电与膀胱内压之间的相关系数是r=0．8790。体表记录的脉冲串的平均振幅和频率与从膀胱壁记录到的均有明显相关（r=0．9371和r=0．9930），前者比后者的振幅明显下降（t=44．41，P〈0．01），频率之间的差异则无统计学意义（t=-0．83，P〉0．05）。结论从体表记录兔膀胱平滑肌的电活动是可行的，体表膀胱电反映了膀胱壁平滑肌的电活动及功能活动，它们之间有高度的相关性。该方法有可能运用于临床．为膀胱的功能活动提供一种无创的检测方法。     

家兔小肠动脉介入栓塞后对肠道平滑肌电活动的影响

目的研究介入动脉栓塞后对小肠肌电活动的影响,为小肠病变栓塞治疗后监测肠管存活和指导临床处理提供理论依据。方法20只正常家兔,分别经小肠动脉注射PVA(350~550μm)2、6mg和生理盐水2ml,分为2mg组(10只),6mg组(5只)和对照组(5只)。利用微导管动脉栓塞技术,以基本电节律为观察指标,研究各组动脉栓塞后24h小肠肌电活动的改变。结果2mg组小肠动脉PVA栓塞前后慢波频率和波幅分别为(17.83±0.55)次/min、(0.1641±0.0043)mV和(11.59±0.23)次/min、(0.0739±0.0011)mV,慢波频率和波幅明显下降(P<0.01)。6mg组栓塞后3~6h后基本电节律(basalelectricalrhythm,BER)活动逐渐消失,剖腹探查示肠管发生长短不等坏死。对照组小肠动脉生理盐水注射前后慢波频率和波幅分别为(17.89±0.48)次/min、(0.1632±0.0020)mV和(16.95±0.34)次/min、(0.1606±0.0030)mV,慢波频率和波幅无明显变化(P>0.05)。结论小肠动脉介入栓塞后对小肠BER影响显著,近端空肠电活动的慢波频率和波幅明显下降,小肠动脉介入栓塞后对胃肠道平滑肌慢波电活动主要表现为抑制作用,小肠动脉PVA栓塞后有望通过动态监测BER改变来判断肠壁存活与否。     

枳壳、小茴香混合水煎剂对800rad γ射线照射大鼠胃肠肌电的影响

本文观察了中药枳壳、小茴香混合水煎剂(以下简称枳茴汤)对正常大鼠及800 rad γ射线照射大鼠胃肠肌电的影响.正常大鼠灌胃枳茴汤(0.25ml/100g体重,含生药0.25mg)后即刻、30min、1h及6h整个胃肠道的峰波振幅比灌药前均有不同程度的升高,尤其是给药后1、6h胃窦部、幽门括约肌的峰波振幅升高更明显(p<0.05).800radγ射线照射大鼠灌胃枳茴汤后胃窦部的峰波振幅在灌药后6h即恢复至正常水平,在照射后3天升高,4天比照射前升高显著(p<0.05).这表明枳茴汤具有兴奋胃肠道、增强胃肠运动的作用.对800 rad γ线照射大鼠则能增强胃的收缩,这对改善电离辐射引起的胃排空延迟是有益的.     

脂肪基质细胞移植治疗杜氏型肌营养不良的临床观察

目的：观察脂肪基质细胞（ADSCs）移植治疗杜氏型肌营养不良（DMD）前后血清酶学变化及临床效果。方法：选择2009-06～2011-06莱芜市人民医院神经内科DMD患者,其中男性48例,女性3例;年龄1～20岁,平均年龄13.3岁。阳性家族史22例。经莱芜市人民医院伦理委员会同意,并征求患者本人及家人签字同意后,进行自体ADSCs移植治疗,设自身治疗前后血清酶学变化对照方法进行疗效观察,应用四肢肌内注射的方式进行ADSCs移植。结果：ADSCs移植治疗12个月肌力增加者占患者总数的64.8%。血清肌酸激酶（CK）降低率80.4%,血清乳酸脱氢酶（LDH）降低率78.4%。结论：ADSCs移植治疗DMD,对肌肉组织有一定的修复作用,使DMD患者的运动功能得到改善,肌力有所提高,血清酶学较移植前下降。ADSCs移植无不良反应,患者依从性好,是治疗DMD的新手段。     

小儿腹泻外敷散对腹泻大鼠小肠Cajal细胞超微结构及血管活性肠肽受体1表达的影响

目的探讨小儿腹泻外敷散对腹泻大鼠小肠Cajal间质细胞(ICC)和血管活性肠肽受体1(VIP-R1)表达的影响。方法 30只Wistar大鼠随机分为对照组、模型组、药物组,每组10只。采用番泻叶水煎液灌胃(2ml/100g)的方法建立腹泻模型,药物组给予小儿腹泻外敷散贴敷。采用透射电镜观察药物对腹泻大鼠小肠ICC超微结构的影响,免疫组化法观察VIP-R1在腹泻大鼠小肠内的分布,RT-PCR和Western blotting测定VIP-R1 m RNA和蛋白表达水平。结果药物贴敷可使ICC形态和缝隙连接基本恢复正常。VIP-R1主要分布在小肠组织环形肌与纵形肌之间、小肠组织肌间神经丛处、结肠黏膜层上皮细胞及固有层细胞的周围。小儿腹泻外敷散可抑制VIP-R1分泌并下调VIP-R1 m RNA及蛋白表达。结论小儿腹泻外敷散可修复腹泻大鼠损伤的ICC细胞,同时可通过下调VIP-R1表达而治疗腹泻。     

凝视手机对青年女性行走时足底压力及下肢表面肌电的影响

目的:探讨凝视手机对青年女性行走时足底压力及下肢表面肌电的影响。方法:运用Footscan高频足底压力测试系统和BTS FREEEMG300型号的32导无线表面肌电系统对16名青年女性正常行走与凝视手机行走进行测量,比较两种状态步行过程中步长、跨步长、步宽,足底各区域压力峰值、接触面积、冲量、足着地过程时相及均方根振幅等指标的变化。结果:青年女性凝视手机行走改变了正常行走步态特征,主要表现在步长变短、步宽变小(P<0.05)、前掌接触阶段和整足接触阶段所占支撑期的百分比增加(P<0.05);低头凝视手机行走时足底第3跖骨、第4跖骨和足跟外侧区域的峰值压力高,与地面接触面积大(P<0.05));与正常行走相比,凝视手机行走足底第3跖骨、第2跖骨、第1跖骨所受冲量较大(P<0.05);凝视手机行走步态周期不同时相的下肢各肌肉参与程度较低。结论:凝视手机行走使用了更为谨慎的步态;凝视手机行走容易导致足底出现疲劳和损伤;凝视手机行走时神经肌肉的控制程度减弱。     

模拟不同高度对清醒兔奥狄氏括约肌运动功能的影响

目的 在低压舱中模拟不同高度，观察兔奥狄氏括约肌动力的变化。方法 建立兔慢性奥狄氏括约肌测压模型，应用低顺应性毛细管水灌注腔内测压系统记录清醒兔奥狄氏括约肌收缩活动。在基础状态（地面水平）、模拟升至3000m和5000m高度分别记录奥秋氏括约肌压力30min。结果 ①在5000m高度，兔奥狄氏括约肌基础压力明显比基础状态时降低（P＜0．01）；②在5000m高度，兔 奥狄氏括约肌时相收缩的频率、振幅和动力指数明显降低（P＜0．01），时相收缩的周期时间无明显变化；③3000m高度对兔奥狄氏括约肌动力无显著影响。结论 急性暴露于5000m低压低氧抑制了奥狄氏括约肌的运动功能。     

Characterization of basal hepatic bile flow and the effects of intravenous cholecystokinin on the liver,sphincter, and gallbladder in patients with sphincter of Oddi spasm

The major objectives of this project were to establish the pattern of basal hepatic bile flow and the effects of intravenous administration of cholecystokinin on the liver, sphincter of Oddi, and gallbladder, and to identify reliable parameters for the diagnosis of sphincter of Oddi spasm (SOS). Eight women with clinically suspected sphincter of Oddi spasm (SOS group), ten control subjects (control group), and ten patients who had recently received an opioid (opioid group) were selected for quantitative cholescintigraphy with cholecystokinin. Each patient was studied with 111–185 MBq (3–5 mCi) technetium-99m mebrofenin after 6–8 h of fasting. Hepatic phase images were obtained for 60 min, followed by gallbladder phase images for 30 min. During the gallbladder phase, 10 ng/kg octapeptide of cholecystokinin (CCK-8) was infused over 3 min through an infusion pump. Hepatic extraction fraction, excretion half-time, basal hepatic bile flow into the gallbladder, gallbladder ejection fraction, and post-CCK-8 paradoxical filling (>30% of basal counts) were identified. Seven of the patients with SOS were treated with antispasmodics (calcium channel blockers), and one underwent endoscopic sphincterotomy. Mean (±SD) hepatic bile entry into the gallbladder (versus GI tract) was widely variable: it was lower in SOS patients (32%±31%) than in controls (61%±36%) and the opioid group (61%±25%), but the difference was not statistically significant. Hepatic extraction fraction, excretion half-time, and pattern of bile flow through both intrahepatic and extrahepatic ducts were normal in all three groups. Gallbladder mean ejection fraction was 9%±4% in the opioid group; this was significantly lower (P<0.0001) than the values in the control group (54%±18%) and the SOS group (48%±29%). Almost all of the bile emptied from the gallbladder refluxed into intrahepatic ducts; it reentered the gallbladder after cessation of CCK-8 infusion (paradoxical gallbladder filling) in all eight patients with SOS, but in none of the patients in the other two groups. Mean paradoxical filling was 204% (±193%) in the SOS group and less than 5% (P<0.05) in both the control and the opioid group. After treatment, six of the SOS patients had complete pain relief and one, partial pain relief. The basal tonus of the sphincter is variable in patients with SOS, and allows relatively more of the hepatic bile to enter the GI tract than the gallbladder. Due to simultaneous contraction of the sphincter and gallbladder in response to CCK-8, most of the bile emptied from the gallbladder refluxes into intrahepatic ducts, and reenters the gallbladder immediately after cessation of hormone infusion. The characteristic features of gallbladder filling, emptying, and paradoxical refilling with cholecystokinin provide objective parameters for noninvasive diagnosis of SOS by quantitative cholescintigraphy.     

Gd-EOB-DTPA增强MRI对Oddi括约肌及胆囊管功能的动态评估

目的:探讨正常志愿者行Gd-EOB-DTPA动态增强MRI中,Gd-EOB-DTPA在十二指肠内及胆囊内显影的时间,为胆道系统功能障碍疾病的诊断提供依据.方法:前瞻性纳入30例行Gd-EOB-DTPA MRI增强扫描的志愿者,于注射对比剂后第5～90 min内连续动态扫描.扫描时间点分别为第5～30 min内每间隔1 min、第30～60min内每间隔5 min、第60～90 min内每间隔10 min采集一次图像.由2位放射科医生对图像进行共同评估,记录对比剂分别进入十二指肠及胆囊的时间.结果:Gd-EOBDTPA进入十二指肠的平均时间为(30±23) min,其中注射Gd-EOB-DTPA延迟扫描20 min时,对比剂进入十二指肠者所占比例为50.0％(15/30);延迟30 min时所占比例为70.0％(21/30);延迟60 min时所占比例为90.0％(27/30).对比剂进入胆囊的中位时间为10 min(6～29 min),其中注射Gd-EOB-DTPA延迟扫描15 min时,对比剂进入胆囊者所占比例为83.3％(25/30);延迟20 min时所占比例为93.3％(28/30);延迟30 min时所占比例为100％(30/30).对比剂进入十二指肠及胆囊时间与年龄无关(P＞0.05).结论:正常人行Gd-EOB-DTPA MRI增强扫描中,对比剂通过十二指肠乳头进入十二指肠的时间＜60 min,而通过胆囊管进入胆囊的时间＜30 min,此时间不仅可为Gd-EOB-DTPA MRI增强检查扫描时间方案的制定提供指导,同时可为临床上怀疑Oddi括约肌功能障碍或急性胆囊炎的排除诊断提供依据.     

A noninvasive test of sphincter of Oddi dysfunction in postcholecystectomy patients: the scintigraphic score.

The ideal noninvasive test of sphincter of Oddi dysfunction (SOD) does not exist and the diagnosis of patients with postcholecystectomy pain often relies on invasive procedures. In this paper we describe a scintigraphic test for SOD: the scintigraphic score. This score combines quantitative and visual criteria for interpretation of hepatobiliary scans. Twenty-six consecutive postcholecystectomy patients underwent hepatobiliary imaging, ERCP, and sphincter manometry. Twelve patients had SOD and 14 had normal sphincters determined by clinical findings, ERCP, and manometric studies. All patients with normal sphincter had scores of 0-4, while patients with SOD had values of 5-12 for a perfect sensitivity and specificity of 100%. Hepatobiliary scans scored in this fashion may become the noninvasive test of choice to screen postcholecystectomy patients with suspected SOD.     

Differentiation between organic stenosis and functional dyskinesia of the sphincter of Oddi with amyl nitrite-augmented quantitative hepatobiliary scintigraphy

Recurrent biliary pain after cholecystectomy is presumably due to sphincter of Oddi dysfunction (SOD). There is no ideal non-invasive test for SOD, and the diagnosis often relies on invasive procedures such as sphincter of Oddi (SO) manometry. Amyl nitrite-augmented quantitative hepatobiliary scintigraphy (QHBS) was performed on nine asymptomatic volunteers and 22 patients with SOD of biliary types I and II. Normal QHBS parameters were established in the asymptomatic volunteers. QHBS revealed a partial obstructive pattern in nine patients in whom SO stenosis was suspected and in 13 patients in whom SO dyskinesia was suspected. This obstructive pattern remained unchanged in the former group, but was completely relieved in the latter group of patients on amyl nitrite administration. In conclusion, amyl nitrite-augmented QHBS proved to be a useful non-invasive method in the diagnosis of SOD of biliary types I and 11 and permitted differentiation between organic stenosis and functional motor abnormalities of the SO. Correspondence to: L. Madácsy