犬迷走神经干切断术对Oddi括约肌的影响

 目的 建立双侧迷走神经干切断术动物模型,研究迷走神经对Oddi括约肌(Sphincter of Oddi,SO)的调节作用.方法 成年杂种犬禁食16～18 h(可自由饮水)麻醉后,实验组行膈肌水平双侧迷走神经干切断术加幽门成形术,对照组仅行幽门成形术.手术8周后行Oddi括约肌测压(SOM)及肌电记录(SOE),SOM和SOE前超声检查测定胆总管内径,SOM和SOE后取胆囊内胆汁肉眼观察.结果 对照组比较,实验组胆总管内压明显升高,内径明显增粗,胆汁内全部出现絮状泥沙样沉淀;实验组SO基础压明显升高,收缩幅度、频率及收缩时间无显著性变化,慢波幅度明显升高,快波无显著性变化.结论 迷走神经对SO运动具有抑制作用,膈肌水平双侧迷走神经干切断术导致SO肌电慢波幅度明显增高,基础压明显提高,胆道动力学发生明显变化.     

春砂仁提取液对胃电活动的影响

目的：研究春砂仁提取液对清醒、空腹状态下人体表胃电和麻醉大鼠浆膜胃电的影响。方法：用胃肠电检测系统记录人体表胃电和大鼠浆膜胃电。结果：春砂仁提取液显著升高人体表胃电和麻醉大鼠浆膜胃电慢波幅度（n=20,P〈0．01）,不影响胃电频率。结论：人体表胃电能客观反映胃的电活动,春砂仁提取液可以升高胃电慢波的幅度,而不影响其频率。     

豚鼠壶腹Cajal样细胞的分布及Oddi括约肌肌电活动观察

目的 研究成年豚鼠壶腹处Cajal样细胞(ICLC)的分布及Oddi括约肌(SO)的肌电活动.方法 取成年豚鼠壶腹全层铺片,c-Kit免疫细胞化学染色观察ICLC的分布情况;采用黏膜接触电极记录豚鼠SO的肌电活动.结果 壶腹的外侧壁和内侧壁均可观察到c-Kit阳性ICLC,位于环形和纵行平滑肌层内以及两层平滑肌之间.肌内的ICLC细胞呈梭形.肌间的ICLC胞体呈椭圆形或三角形,发出3个以上的有分支的突起,这些细胞相互连接排列成网络状,与十二指肠的肌间丛Cajal间质细胞(IOCs)十分相似.在壶腹外侧壁的内面ICLC与十二指肠的深肌丛ICCs相似.壶腹的内侧壁肌层有大量的ICLC,与平滑肌细胞平行走行.在壶腹开口处,ICLC围绕开口形成一个ICLC环.在SO记录到自发节律性的肌电活动波.结论 壶腹内的ICLC可能参与SO自主节律性运动的调控并与SO运动障碍的发生有关.     

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。     

胆囊切除术后Oddi氏括约肌的功能评价

目的：用胆道灌注压法，观察胆囊切除前后Ｏｄｄｉ氏括约肌压力变化，评价其功能改变。方法：测量８例健康成人，７例胆囊切除术后及８例胆囊结石者在禁食状态下Ｏｄｄｉ氏括约肌段压力。结果：人Ｏｄｄｉ氏括约肌段存在长约５～１０ｍｍ的功能性高压带，呈节律性时相性收缩。胆囊切除组Ｏｄｄｉ氏括约肌基础压（０．１６２±０．１５ｋＰａ）较正常组（２．２８±０．２１ｋＰａ）明显降低，收缩持续时间（７．００±１．２２ｓ）也较正常组（８．３０±０．６４ｓ）短，经统计学处理，差异显著。胆囊结石组与健康成人组各项测压指标均无显著差异。结论：人Ｏｄｄｉ氏括约肌在禁食状态下节律性及时相性收缩，高压带起阀门作用，胆囊具有稳定此高压带的作用。胆囊切除后Ｏｄｄｉ氏括约肌段压力降低，可能是引起胆道继发感染的重要因素之一。     

宫颈癌术后盆底功能障碍患者盆底电生理指标与盆底超声检查结果相关性分析

目的 探究宫颈癌术后盆底功能障碍患者盆底电生理指标与盆底超声检查结果相关性。方法 回顾性分析2018年2月—2021年7月于苏州高新区人民医院诊断为宫颈癌并行手术治疗的患者50例,所有患者均接受盆底电生理指标检查,根据患者术后盆底功能分为正常组（24例）和障碍组（26例）。分析盆底电生理指标检查与超声检查结果的相关性。结果 正常组前静息阶段的肌电平均值明显低于障碍组,慢肌阶段与耐力阶段的肌电平均值明显高于障碍组,快肌阶段与慢肌阶段的肌电最大值明显高于障碍组,快肌阶段的肌电下降时间明显低于障碍组,耐力阶段的肌电前10 s平均值与后10 s平均值明显高于障碍组,慢肌阶段、耐力阶段的肌电变异性明显低于障碍组,以上差异均具有统计学意义（P<0.05）;而2组前静息阶段的肌电变异性、快肌阶段的肌电上升时间、后静息阶段的肌电平均值以及变异性差异无统计学意义（P>0.05）。快肌阶段肌电下降时间（P=0.003）与盆底功能障碍发生呈正相关（P<0.05）;快肌阶段肌电最大值（P=0.020）、慢肌阶段肌电最大值（P=0.012）、耐力阶段肌电前10 s平均值（P=0.012）、耐力...     

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。     

成年健康母牛瓣胃生物电活动和运动基本规律的研究

本文采用胃肌电记录技术和腔外应力传感器技术同步记录了成年健康母牛瓣胃不同区域和不同生理条件下（静息、反刍、采食）生物电和运动变化，获得了两种电活动变化：①慢电位：又分成两种波形（ｉ）类正弦波和（ｉｉ）不规则波。这两种波形具区域性差异，在三种生理条件下两种波形的各项指标间均具有极显著异（Ｐ＜０．０１）。②成簇放电：近网瓣口处以高频、高幅、时程较短为特征，该种成簇放电与网胃电活动关系密切；而瓣胃体大部     

内源性乙酰胆碱对大鼠胃电节律的影响

目的：探讨内源性乙酰胆碱对胃肌电节律的影响及胃电节律失常发生的机理。方法：用Wistar大鼠28只随机分为3组;正常对照组：12只;模型组：8只,按隔日禁食方法喂养4周,药物组;8只,观察胃肌电参数和肌间神经丛胆碱能神经分布与定量。结果：新斯的明及不同剂量阿托品（ARI）、慢波频率变异系数（CV）均明显高于正常对照组,胃肌间神经丛内胆碱能神经明显减少,小剂量阿托品并不引起胃电节律失常;新斯的明及大剂量阿托品注射后,胃电节律失常明显增加,结：内源性乙酰胆碱增加或减少均可使胃电节律失常增加。     

消化间期胃肠移行性复合运动及其机制研究进展

在清醒空腹状态下胃肠运动呈现周期性，此种运动形式称为移行性复合运动（ＭｉｇｒａｔｉｎｇＭｏｔｉｌｉｔｙＣｏｍｐｌｅｘ，ＭＭＣ）。以电活动为指标研究胃肠运动时，将这种周期性变化称为消化间期综合肌电（ＩｎｔｅｒｄｉｇｅｓｔｉｖｅＭｙｏｅｌｅｃｔｒｉｃＣｏｍｐｌｅｘ，ＩＭＣ）。本文就ＭＭＣ的启动和移行机制研究进展作一概述。１　ＭＭＣ及其移行的特点ＭＭＣ分为四期：第一期，带锋电位的慢波少于５％，无明显的收缩活动，历时４５～６０ｍｉｎ。第二期，锋电位和收缩运动逐渐增多，带锋电位的慢波达５％～９５％，历时３…     

The dilated common duct sign. A potential indicator of a sphincter of Oddi dyskinesia

The cholescintigraphic findings of a Sphincter of Oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the Sphincter of Oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. We postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the Sphincter of Oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.     

某部基层官兵功能性胃肠疾病近况调查及相关因素分析

目的探讨某部基层官兵功能性胃肠疾病（functional gastrointestinal disorders,FGIDs）的发病情况及其相关影响因素。方法按照FGIDs罗马Ⅲ分类及诊断标准,对某部官兵1882人采用多级分层随机整群抽样方法进行问卷调查。按国际统一评判方法（SA for RomeⅢ-DQ）对各种功能性胃肠疾病进行诊断。选择调查目前某部官兵存在的功能性消化道疾病,包括：①功能性消化不良（上腹痛综合征及餐后不适综合征）;②肠易激综合征（irritable bowe syndrome,IBS）,以腹泻为主型IBS及便秘为主型IBS③功能性腹胀;④功能性便秘、胆系疼痛（胆囊及Oddi＇s括约肌功能紊乱）。结果①抽样调查官兵1882人FGIDs总发病人数501例,总发病率为26.63%。其中功能性腹胀发病率最高为8.66%;其次为功能性消化不良6.91%,IBS5.79%,慢性功能性便秘4.57%;而胆囊及Oddi＇s括约肌功能紊乱发病率较低,均不到1%。功能性消化不良中的上腹痛综合征发病率为3.35%;餐后不适综合征发病率为3.56%;IBS中的腹泻为主型IBS发病率为2.92%,便秘为主型IBS发病率为2.96%。②各类FGIDs发病率依次为功能性肠病19.02%,功能性胃十二指肠疾病6.91%,功能性胆囊及Oddi＇s括约肌功能紊乱0.70%。③在FGIDs发病人群中吸烟比率达89.42%,存在饮酒史的占74.05%,明显高于不吸烟、饮酒的人群。结论在官兵中占有相当比例的FGIDs,一定程度上影响到官兵正常训练及执行作战任务,应采取相应干预措施降低其发病率。     

Sphincter of Oddi dysfunction: two case reports and a review of the literature

Sphincter of Oddi dysfunction is an underdiagnosed but important clinical condition. It should be considered in the differential diagnosis of biliary pain when the gallbladder sonogram shows no evidence of gallbladder disease. Hepatobiliary scanning (Tc-99m dimethyl iminodiacetic acid) may provide valuable information in the evaluation of these patients and may be helpful in monitoring response to treatment.     

MSCT对胆囊结石并十二指肠瘘的诊断价值

目的：探讨MSCT对胆囊结石并十二指肠瘘的诊断价值。方法：回顾性分析6例经手术证实的胆囊结石并十二指肠瘘的CT表现。结果：6例患者中,胆囊萎缩4例,胆囊体积增大2例;胆囊内结石4例,胆囊无结石2例;胆囊壁钙化2例,胆囊内积气2例,胆管积气1例;6例胆囊周围结构显示均欠清晰,4例软组织块影包绕胆囊及十二指肠,3例结石性肠梗阻,结石位于回肠末端。结论：MSCT具有较高的密度分辨力及空间分辨力,结合多平面重组及临床资料,可对胆囊结石并十二指肠瘘的诊断提供重要信息。     

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     

Functional hepatobiliary disease: chronic acalculous gallbladder and chronic acalculous biliary disease

Chronic acalculous gallbladder and chronic acalculous biliary disease are considered functional hepatobiliary diseases. Cholescintigraphy provides physiologic imaging of biliary drainage, making it ideally suited for their noninvasive diagnosis. For chronic acalculous gallbladder disease, calculation of a gallbladder ejection fraction during sincalide cholescintigraphy can confirm the clinical diagnosis and has become a common routine procedure in many nuclear medicine clinics. Published data generally confirm a high overall accuracy for predicting relief of symptoms with cholecystectomy. However, data also exist suggesting it is not useful. The discrepant results probably are caused by the various different methodologies that have been used for sincalide infusion. Proper methodology of sincalide infusion is critical for providing accurate reproducible results, minimizing false positive studies, and preventing adverse side effects. The most common causes for the postcholecystectomy pain syndrome are partial biliary obstruction secondary to stones or tumor and sphincter of Oddi dysfunction. The latter is a partial biliary obstruction at the level of the sphincter. This has long been considered a functional hepatobiliary disease because of the lack of anatomical abnormalities. Sphincterotomy is the present treatment; however, diagnosis requires invasive procedures, such as endoscopic retrograde cholangiopancreatography and sphincter of Oddi manometry, which has a high complication rate and is not widely available. The unique ability of cholescintigraphy to image biliary drainage allows noninvasive diagnosis. Different methodologies have been reported, many with good overall accuracy. Various pharmacologic interventions and quantitative methodologies have been used in conjunction with cholescintigraphy to enhance its diagnostic capability. Further investigations are needed determine the optimal methodology; however, cholescintigraphic methods have already a clinical role in the diagnosis of sphincter of Oddi dysfunction and will be used increasingly in the future.     

口服枸橼酸铁铵在MRCP评价胆囊切除术后残余胆囊管显像中的价值

目的:探讨口服枸椽酸铁铵对MRCP评价胆囊切除术后残余胆囊管显像的价值。方法:采用呼吸导航3DFSE T2WI及单次屏气2D厚层FSE T2WI对55例胆囊切除术后患者进行检查,其中27例口服枸椽酸铁铵,28例空腹检查,比较2组患者残余胆囊管显示效果及胃十二指肠伪影情况。结果:27例口服枸椽酸铁铵3D MRCP残余胆囊管显示率为96.3%(26/27),2D MRCP为92.6%(25/27),均出现胃十二指肠伪影2例(7.4%)。28例空腹组3D MRCP残余胆囊管显示率为85.7%(24/28),2D MRCP为46.4%(13/28),均出现胃十二指肠伪影27例(96.4%)。结论:口服枸椽酸铁铵可明显消除胃液影响,明显提高MRCP对胆囊切除术后残余胆囊管的显示率及图像质量。     

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.