EST对胆囊切除术后Oddi括约肌功能障碍胆道型的治疗价值

目的：探讨内镜下十二指肠乳头切开术（EST）对胆囊切除术后Oddi括约肌功能障碍（Sphincter of Oddi Dysfunction,SOD)胆道型的治疗价值。方法：参考SOD国际诊断标准（罗马Ⅱ），拟定关于胆道型SOD的标准选择72例SOD患者，经ERCP确诊后，及时进行EST治疗，采用Pull式十二指肠乳头切开刀进行切开，切口长度约1－1.5cm，其中12例狭窄型患者应用针型切开刀开窗后，再行ERCP成功。术后观察疗效，以显效、有效和无效来评价，并观察分析并发症情况。结果：72例患者经EST治疗后，显效58例（80．6％），有效9例（12．5％），总有效率为93．1％；无效5例（6．9％）。EST术中及术后出现并发症9例（12．5％），其中出血4例，急性胰腺炎3例，胆系感染2例。结论：EST对SOD患者具有非常确切的疗效，且患者痛苦小，住院时间短。     

Oddi括约肌压力测定及内镜下十二指肠乳头括约肌切开术对Oddi括约肌功能紊乱诊治的意义

目的针对反复右上腹痛的患者进行Oddi括约肌测压,以评价Oddi括约肌测压术(SOM)在慢性胆胰疾病诊治中的应用价值,并探讨内镜下十二指肠乳头切开术(EST)对Oddi括约肌基础压升高患者的疗效。方法回顾分析该院2012年10月-2014年9月30例慢性上腹痛疑似Oddi括约肌功能紊乱(SOD)的患者在内镜逆行胰胆管造影术(ERCP)检查时接受SOM的临床资料,观察Oddi括约肌基础压、收缩幅度、频率和传播方式。对Oddi括约肌基础压40.0 mm Hg者及30.0 mm Hg并存在血淀粉酶、脂肪酶、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(AKP)升高超过正常值2倍以上和(或)胆总管、胰管管增宽者行EST治疗,并随访其疗效。结果 30例患者SOM均存在不同程度的异常,Oddi括约肌基础压力为(36.6±21.1)mm Hg,收缩幅度为(210.6±25.7)mm Hg,收缩频率为(10.1±3.1)次/min,逆向收缩率为(55.0±8.0)%。30例患者均接受EST治疗,术后随访,其中27例(90.0%)有效。结论 SOM助于评价Oddi括约肌功能,对诊断SOD具有较大价值,测压发现Oddi括约肌基础压升高患者EST治疗可获得满意疗效。     

Oddi括约肌功能障碍的EST治疗价值

目的探讨内镜下乳头括约肌切开术(Endoscopic Sphincterotomy,EST)对Oddi括约肌功能障碍(Sphincter of Oddi Dsfunction,SOD)的治疗价值.方法对35例胆囊切除术后综合征和复发性胰腺炎患者经内镜逆行胰胆管造影(Endoscopic Retrograde Cholangiopancteatography,ERCP)检查,在除外胆囊、胆管和胰管器质性病变的前提下,对最后诊断为Oddi括约肌功能障碍的35例患者行EST治疗.术后观察疗效,以显效、有效和无效为评价治疗效果,同时观察并发症情况.结果35例患者行EST治疗后显效15例(42.9%),有效16例(45.7%),无效4例(11.4%),总有效率为88.6%.EST治疗后无并发症发生.结论EST对SOD引起的胆囊切除术后综合征和复发性胰腺炎患者是一种微创、安全、有效的治疗手段.     

内镜下十二指肠乳头括约肌切开术治疗Oddi括约肌功能失调(附69例报告)

目的观察内镜下十二指肠乳头括约肌切开术（EST）对胆囊切除术后Oddi括约肌功能失调（SOD）的疗效。方法根据患者病史、临床症状、ERCP检查及肝功能改能变等进行综合诊断，对诊断为SOD的92例患者先行内科药物治疗，有69例接受EST治疗。结果药物治疗总有效率为20．7％（19／92），EST治疗总有效率为92．8％（64／69），明显优于药物治疗（P〈0．01）。结论对早期的轻症SOD患者，药物治疗是首选；对药物治疗失败者或中晚期的狭窄型SOD患者，EST是一种微创、安全和有效的治疗手段。     

内镜下括约肌切开术治疗Oddi括约肌功能障碍

目的：通过内镜将十二指肠乳头括约肌切开（Endoscopic-sphincterotomy,EST)治疗Oddi括约肌功能障碍（Shpincter of Oddi Dysfunction,SOD)。方法：25例胆囊切除术后的患者于术后出现胆绞痛症状，肝功能改变，经B超、CT检查发现胆总管扩张，但又未发现结石及肿瘤，并排除其他疾病。内科药物治疗无效。经ERCP检查发现胆总管扩张≥12mm，造影剂排空延迟，考虑为Oddi乳头括约肌功能障碍，行内镜下乳头括约肌切开术。结果：全部病人切开后腹痛即刻消失。效果良好，有9例患者术后出现少量上消化道出血，经内科治疗后出血停止，其余病人无其它严重并发症；3月后随访仅1例出现轻度上腹部胀痛。结论：内镜下乳头括约肌切开术是治疗Oddi乳头括约肌功能障碍的有效方法。     

内镜下胆胰管逆行造影、T管会师术在十二指肠乳头括约肌功能紊乱诊治中的应用研究

目的 探讨经内镜下胆胰管逆行造影(ERCP)、T管会师行乳头括约肌切开术(EST)治疗十二指肠乳头括约肌功能紊乱(SOD)及胆总管结石的临床效果.方法 收集该院2005年5月～2009年5月经ERCP、T管会师行内镜下乳头括约肌切开术(EST)的SOD患者36例,并对患者的临床资料进行分析.结果 36例患者ERCP直接...     

早期内镜胆总管Oddi括约肌切开术治疗急性胆源性胰腺炎

目的：探讨早期内镜胆总管Oddi括约肌切开术(EWT)治疗急性胆源性胰腺炎的临床疗效。方法：对42例经内镜胆总管Oddi括约肌切开术和经内镜鼻胆管引流术(ENBD)等内镜技术治疗的急性胆源性胰腺炎的临床资料进行分析。结果：42例急性胆源性胰腺炎患者，经内镜Oddi括约肌切开后4l例得到治愈，l例先天性胆总管囊肿、胆胰管合流异常的病例在EST和ENBD后病情缓解，但3月后再次发生急性胰腺炎．经胆总管囊肿切除后才治愈。22例急性胆管炎经ENBD后也迅速缓解，26例胆总管结石在EST后结石自行排出或用网蓝取出；20例胆囊结石在胰腺炎治愈后择期行腹腔镜胆囊切除术，消除胰腺炎的诱发因素。结论：内镜治疗直接针对胆源性胰腺炎的发病原因，解除胆胰管开口的梗阻，排除梗阻因素，通畅胆胰液的引流，降低胆胰管内压，起到了良好的治疗作用，有助于防止轻症胰腺炎向重症转化，是临床上治疗胆源性胰腺炎的一种有价值的治疗方法。     

内镜下乳头括约肌小切开术联合球囊扩张术在轻中度胆源性胰腺炎治疗中的价值

目的探讨应用内镜下乳头括约肌小切开术(s EST)联合球囊扩张术(EPBD)治疗轻中度胆源性胰腺炎患者的临床疗效。方法筛选出2013年1月-2015年12月因轻中度胆源性胰腺炎入住该院的60例患者,并随机分为对照组、单纯内镜下乳头括约肌切开术(EST)组和s EST+EPBD组,每组20例。比较分析3组患者分组当日血清学指标、术后炎症指标、手术并发症、住院情况指标以及随访情况指标。结果 3组患者分组当日血清淀粉酶、C反应蛋白(CRP)及降钙素原(PCT)值比较差异无统计学意义(P0.05)。EST组和s EST+EPBD组总住院时间明显短于对照组(P0.05),且s EST+EPBD组总住院费用明显低于对照组(P0.05);另外,EST组和s EST+EPBD组1年内均无胆源性胰腺炎发生,并均成功实现胆囊切除,而对照组12例复发,仅10例完成胆囊切除。s EST+EPBD组术后血清淀粉酶水平明显高于EST组,而总住院时间、费用以及手术并发症明显低于EST组(P0.05);然而,随访1年时间内,两组患者均无胆源性胰腺炎复发,并均最终实现胆囊切除,两组之间无明显差异。结论 s EST+EPBD是治疗轻中度胆源性胰腺炎的一种有效的、安全的方法,能减少住院时间及费用,降低术后并发,有利于患者间期实施腹腔镜下胆囊切除术。     

腹腔镜胆囊切除术后Oddi括约肌功能障碍的内镜治疗体会(附26例报告)

目的：探讨内镜乳头括约肌切开术对腹腔镜胆囊切除(laparcscopic cholecystectomy,LC)术后Oddi括约肌功能障碍在外科临床治疗中的应用价值。方法：腹腔镜胆囊切除术后综合征患者行B超、经内镜逆行胰胆管造影检查，测定Oddi括约肌基础压，排除胆管残留或再生结石、胆管狭窄及胆道肿瘤等病变，对最后诊断为Oddi括约肌功能障碍的26例腹腔镜胆囊切除术后患者行内镜下乳头括约肌切开术。并发急性胆道感染者给予ENBD治疗。结果：20例患者术后症状基本消失，2例症状明显缓解，2例2次行内镜下乳头括约肌切开术后症状得到缓解，2例术后症状无缓解，手术有效率达92．3％(24／26)，治疗后恢复快，并发症极少。结论：ERCP对腹腔镜胆囊切除术后Oddi括约肌功能障碍的诊断价值高，内镜下乳头括约肌切开术对腹腔镜胆囊切除术Oddi括约肌功能障碍是一种微创、安全、有效的治疗手段，约76．9％可治愈。缩短了住院时间，病人痛苦少，恢复快。     

解剖困难性内镜乳头括约肌切开术(附76例报告)

目的 探讨解剖困难性内镜十二指肠乳头括约肌切开技术(EST).方法 对38例胃BillrothⅡ式术后、30例十二指肠乳头旁憩室以及8例胰腺分裂型慢性胰腺炎患者进行EST治疗.结果 63(82.9%)例EST获成功,13(17.1%)例失败,7(9.2%)例并发中等量以上消化道出血,无肠穿孔和死亡.结论 解剖困难性EST技术仍然安全可行.     

Suspected sphincter of Oddi dysfunction type II: empirical biliary sphincterotomy or manometry-guided therapy?

BACKGROUND AND STUDY AIMS: Sphincter of Oddi manometry is considered to be the gold standard for diagnosing sphincter of Oddi dysfunction (SOD). Elevated basal sphincter pressures are found in about half of the patients with findings consistent with biliary type II SOD, and most of these patients will symptomatically improve after endoscopic sphincterotomy. Since manometric sphincter evaluation is not widely available, a decision analysis was used to compare the overall costs and outcomes of manometry-directed therapy with "empirical" sphincterotomy in patients with suspected biliary type II SOD. PATIENTS AND METHODS: A decision analysis model was constructed using a software program. In a hypothetical cohort of 100 patients with suspected type II SOD, the following strategies were evaluated: a). endoscopic retrograde cholangiopancreatography (ERCP) with manometry followed by biliary sphincterotomy only if an elevated sphincter of Oddi basal pressure was found; and b). "empirical" biliary sphincterotomy without manometry. Data on the probability of an elevated sphincter of Oddi basal pressure at the time of ERCP in patients with suspected biliary SOD type II, the proportion of patients who improved after biliary sphincterotomy (with and without elevated basal pressures), the proportion of patients who improved without biliary sphincterotomy, complications, and death were obtained from the literature and from our center. The procedural and hospitalization costs represented the average Medicare reimbursement at our institution. The expected overall costs and numbers of patients improving with each strategy were compared.[nl] RESULTS: The strategy of ERCP with manometry resulted in total costs of US dollars 2790 per patient, whereas a strategy of "empirical" biliary sphincterotomy resulted in total costs of US dollars 2244. In a cohort of 100 patients with suspected SOD, 55 % of patients would be expected to improve if manometry were performed, compared to 60 % of patients improving with "empirical" biliary sphincterotomy. Univariate sensitivity analyses demonstrated that "empirical" biliary sphincterotomy continued to be a cost-saving strategy in comparison with ERCP with manometry as long as the probability of spontaneous improvement in patients with "normal" manometry was less than 41 %, the probability of complications associated with manometry was greater than 6 %, and the probability of complications due to biliary sphincterotomy was less than 19 %. CONCLUSIONS: For patients with suspected biliary SOD type II, empirical biliary sphincterotomy performed by experienced endoscopists appears to be cost-saving in comparison with a strategy based on the results of manometry.     

Botulinum toxin injection after biliary sphincterotomy

BACKGROUND AND STUDY AIMS: Endoscopic biliary sphincterotomy in patients with sphincter of Oddi dysfunction (SOD) is associated with a high risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP), which may be secondary to residual pancreatic sphincter hypertension. It was hypothesized that botulinum toxin injection could be used to reduce pancreatic sphincter hypertension temporarily in SOD patients after biliary sphincterotomy, thereby reducing the rate of procedure-induced pancreatitis. PATIENTS AND METHODS: All patients undergoing ERCP with manometry due to a suspected biliary SOD were asked to participate in the study. Patients with elevated basal sphincter pressures were randomly assigned to receive either botulinum toxin or a sham saline injection after biliary sphincterotomy. Fifty units of botulinum toxin were delivered via a sclerotherapy needle in the form of two 25-U injections of 0.25 ml each into the pancreatic sphincter. In patients in the sham arm, 0.50 ml of saline was injected into the duodenal lumen. RESULTS: Between 12 February 1999 and 29 November 2000, a total of 98 patients were referred for ERCP with manometry; 86 consented to participate in the study, and 26 had elevated baseline pressures and underwent random assignment. Twelve received botulinum toxin injection and 14 were randomly assigned to receive the sham injection. A total of six patients in the sham group (43 %) developed procedure-induced pancreatitis, compared with three patients in the botulinum toxin group (25 %; P = 0.34). CONCLUSIONS: Biliary sphincterotomy in patients with sphincter of Oddi dysfunction without pancreatic protection is risky and should no longer be carried out. This study demonstrates that botulinum toxin injection into the residual pancreatic sphincter after biliary sphincterotomy is technically feasible and safe, showing a trend toward a reduced post-ERCP pancreatitis rate in patients with sphincter of Oddi dysfunction. Further studies will need to confirm the validity of these experimental results before this technique can be used routinely.     

Evaluating the efficacy of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction: A retrospective clinical trial

BACKGROUNDAlthough endoscopic sphincterotomy (EST) has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction (SOD), some patients still have little relief after EST, which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.AIMTo retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder (FGID) in guiding endoscopic treatment of SOD.METHODSClinical data of 79 patients with biliary-type SOD (type I and type II) treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST. The significance of relationship between FGID and biliary-type SOD was analyzed.RESULTSSeventy-nine patients with biliary-type SOD received EST, including 29 type 1 patients and 50 type 2 patients. The verbal rating scale-5 (VRS-5) scores before EST were all 3 or 4 points, and the scores decreased after EST; the difference was statistically significant (P < 0.05). After EST, the serum indexes of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and total bilirubin in biliary-type SOD were significantly lower than before (P < 0.05). After EST, 67 (84.8%) and 8 (10.1%) of the 79 patients with biliary-type SOD had obviously effective (VRS-5 = 0 points) and effective treatment (VRS-5 = 1-2 points), with an overall effectiveness rate of 94.9% (75/79). There was no difference in VRS-5 scores between biliary-type SOD patients with or without FGID before EST (P > 0.05). Of 12 biliary-type SOD (with FGID) patients, 11 had abdominal pain after EST; of 67 biliary-type SOD (without FGID) patients, 0 had abdominal pain after EST. The difference was statistically significant (P <0.05). The 11 biliary-type SOD (with FGID) patients with recurrence of symptoms, the recurrence time was about half a year after the EST, and the symptoms were significantly relieved after regular medical treatment. There were 4 cases of post-endoscopic retrograde cholangiopancreatography pancreatitis (5.1%), and no cholangitis, bleeding or perforation occurred. Patients were followed up for 1 year to 5 years after EST, with an average follow-up time of 2.34 years, and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.CONCLUSIONEST is a safe and effective treatment for SOD. For patients with type I and II SOD combined with FGID, single EST or medical treatment has limited efficacy. It is recommended that EST and medicine be combined to improve the cure rate of such patients.     

内镜下十二指肠乳头括约肌切开术对急性胆源性胰腺炎的治疗价值

目的 探讨急性胆源性胰腺炎早期内镜治疗的价值及其安全性。方法 选择82例急性胆源性胰腺炎患者早期（72h内）行逆行胰胆管造影（endoscopic retrograde cholangiopancreatography，ERCP）及内镜下十二指肠乳头括约肌切开术（endoscopic sphincterotomy，EST）（ERCP组），并与同期保守治疗36例（对照组）进行比较。结果 ERCP组全部成功实施EST，66例胆总管结石者行网篮及气囊取石，所有82例均行鼻胆管引流，重症组8例同时行胰管支架引流。ERCP组平均腹痛消失时间、血清淀粉酶恢复时间、平均住院天数及平均费用均明显低于对照组。ERCP组重症组死亡率8．33％，对照组重症组死亡率33．33％。结论 急性胆源性胰腺炎早期ERCP治疗是安全的，能降低病人的死亡率．减少病人住院天数和费用。     

Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone

BACKGROUND AND STUDY AIMS: Patients with suspected or documented sphincter of Oddi dysfunction (SOD) who undergo standard biliary sphincterotomy have high rates of post-procedure pancreatitis. Approximately 75% of such patients have elevated basal pressures of the pancreatic sphincter. Biliary sphincterotomy (BES) on its own leaves the pancreatic sphincter unablated and may cause transient edema which aggravates the increase in pancreatic sphincter pressure. Combined pancreaticobiliary therapy (PBR), using pancreatic stenting in addition to sphincterotomy may therefore be safer. PATIENTS AND METHODS: The endoscopic retrograde cholangiopancreatography (ERCP) database was queried for patients with successful double-duct sphincter of Oddi manometry (SOM) who underwent BES alone or PBR between 1994 and 1997. The endoscopist had decided on the technique to be used. From 1995 to 1997 there was a general trend to do PBR. Pancreatitis was defined according to established criteria. RESULTS: The post-ERCP pancreatitis rate among all 436 SOD patients was 19.7%, while 256 patients with normal SOM results had a pancreatitis rate of 12.9%. The use of combined PBR was associated with a lower frequency of pancreatitis compared with BES alone (needle-knife over pancreatic duct stent, 14/131 patients, 10.7 %; pull-type pancreaticobiliary sphincterotomy plus pancreatic stent, 15/78 patients, 19.2%; BES alone, 52/184 patients, 28.3%). Episodes of moderate and severe pancreatitis were seen more frequently in the BES group. CONCLUSION: In SOD patients, post-ERCP pancreatitis rates remain high, but have improved with the addition of combined pancreaticobiliary sphincter therapy.     

十二指肠镜治疗高龄急性胆源性胰腺炎的临床应用

目的探讨应用十二指肠镜治疗高龄急性胆源性胰腺炎患者的可行性、有效性和安全性。方法该院2002年5月-2005年10月收治的18例高龄急性胆源性胰腺炎患者首先行内镜下乳头括约肌切开取石，同时置入鼻胆管引流；合并胆囊结石者，待胰腺炎恢复后，施行腹腔胆囊切除术等。结果全组18例病人均行鼻胆管引流（ENBD），11例胆管结石行内镜下乳头括约肌切开取石（EST）取出，胰腺炎顺利治愈17例，治愈率94．4％：6例取石失败。二次内镜治疗行胆道支架引流术、三镜联合胆总管探查术，中转开腹手术治疗，无严重术后并发症发生。结论早期ENBD＋EST，解除胆道梗阻，降低胰管压力，避免急诊手术，为择期手术创造条件，该微创技术尤为适合高龄、合并有多脏器功能不全、难以耐受手术的患者。     

肝移植术后胆道并发症的内镜下诊治

目的初步探讨内镜在肝移植术后胆道并发症诊治中的临床应用价值。方法35例肝移植术后出现胆道并发症患者,共行ERCP124次,其中行ERCP次数最少为1次,最多为17次,平均为3.54次。根据患者的情况进行扩张、EST、取石、鼻胆管引流、内支架置入等治疗。结果13例为单纯的胆道吻合口狭窄,经胆道扩张后胆道梗阻症状解除,其中1例术后4个月因肝癌远处转移死亡;3例为单纯吻合口胆瘘,经EST及支撑管,胆瘘愈合;7例胆道狭窄合并胆瘘,经EST及胆道扩张后放入支撑管,胆瘘愈合;12例胆道狭窄合并狭窄上端胆总管及肝内胆管结石,经胆道扩张后取出部分结石。所有患者经治疗后胆红素、碱性磷酸酶等酶学指标均有不同程度下降,临床症状明显改善,无严重并发症发生。结论内镜对于肝移植术后胆道并发症的诊断与治疗安全而有效,避免了患者再次外科手术。