Oddi括约肌狭窄的诊断与治疗

本文通过对３７５例胆囊、胆总管结石患者术后有残留症状者，经Ｂ超、ＥＲＣＰ、Ｔ管造影诊断为Ｏｄｄｉ括约肌狭窄者１６７例，均经十二指肠镜乳头括约肌切开（ＥＳＴ）治愈。同时讨论了Ｏｄｄｉ括约肌狭窄的原因、临床表现及诊断治疗中注意事项。     

Ⅱ/Ⅲ期低位直肠癌术前同步放化疗的疗效观察

目的评价Ⅱ/Ⅲ期(DukesB/C期)低位直肠癌术前同步放化疗的疗效。方法对23例Ⅱ/Ⅲ期低位直肠癌患者放疗 同步口服希罗达,4～6周后行手术治疗。结果放化疗后肿瘤缩小,手术切除率为100.0%,保肛率为73.9%,局部复发率仅为4.4%,吻合口瘘的发生率为4.4%。结论对于Ⅱ/Ⅲ期(DukesB/C期)低位直肠癌患者术前同步放化疗可以提高手术切除率、保肛率,降低局部复发率,并不增加术后吻合口瘘的发生,是1种较好的治疗手段。     

胆舒通片对胆道系统作用的实验研究

目的观察胆舒通片的利胆、镇痛、抗炎作用。方法用BL-410生物实验系统测定家兔胆囊运动,胆汁流量、Odd i括约肌紧张性和胆道末端内压,并采用相应的药理学模型研究胆舒通片的抗炎、镇痛作用。结果胆舒通片能增加胆囊收缩曲线下面积,显著增加家兔胆囊收缩的频率和收缩幅度,表明胆舒通片有增强胆囊收缩的作用。胆舒通片能促进胆汁分泌,可降低胆道末端内压,具有松弛Odd i括约肌的作用。可提高小鼠的热刺激痛阈,减少醋酸引起的扭体次数;对蛋清性足跖肿胀及对二甲苯引起的耳廓肿胀均有抑制作用,降低毛细血管通透性。结论胆舒通片具有利胆、抗炎、镇痛作用。     

Evaluation of role of bile flow patterns in process of in vitro stent occlusion

Stent placement above the sphincter of Oddi might have advantages over stent placement across the sphincter of Oddi in prolonging stent patency in the treatment for malignant obstructive jaundice. To evaluate the role of bile flow patterns corresponding to biliary stent positioning in the process of stent occlusion in an in vitro bile perfusion model, one group of polyethylene stents was perfused continuously and another group of stents was perfused with additional flushing three times a day, simulating gallbladder emptying. After 8 weeks, the flow rates through the perfused stents were measured for evaluating the extent of stent occlusion indirectly. The results showed that bile flow rate of stents with additional flushing was significantly higher than the continuously perfused stents (P 0.01). It was demonstrated that after 18 hr of perfusion, additional flushing obviously decreased bacterial adherence to stent when compared to continuously perfused stents. In conclusion, flushing of bile may decrease the build-up of substance in vitro and thus improve stent flow rates, for which decreasing bacterial adherence to stents may be responsible.     

钙调神经磷酸酶在兔胆囊切除术后早期Oddi括约肌改变中的作用

目的观察胆囊切除术后早期Oddi括约肌超微结构改变、肌球蛋白重链（MHC）及钙调神经磷酸酶（CaN）催化亚单位α、β（CnAα、CnAβ）2种亚型的表达变化,探讨胆囊切除术后Oddi括约肌的改变及其可能的机制。方法52只新西兰大白兔,分为4组,A、D组各14只,B、C组各12只;A组仅行开腹术暴露胆囊,术后4周取Oddi括约肌标本;B、C、D组行胆囊切除术,分别于术后2、4、8周切取标本。A、D组各取2只行透射电镜检测。余行RT-PCR、Western blot检测CnAα、CnAβ mRNA和蛋白表达变化,Western blot检测MHC蛋白表达变化。结果①Western blot检测到术后2周、4周、8周MHC蛋白表达逐渐增加（P〈0.01）;透射电镜示术后8周平滑肌细胞内密体增多。②RT-PCR检测到术后4周、8周与对照组比CnAβ mRNA表达增加,8周比4周降低（P〈0.01）。③Western blot检测到术后2周、4周、8周CnAβ蛋白表达逐渐增加（P〈0.01）。④CnAα mRNA及蛋白表达均无显著变化。结论兔胆囊切除术可致Oddi括约肌组织超微结构发生改变、肌球蛋白重链表达增加;肌球蛋白重链表达增加可能与CnAβ表达增高有关,这可能是Oddi括约肌功能紊乱（SOD）多发生于胆囊切除术后患者的分子机制之一,可能在胆囊切除术后SOD的发病过程中起一定的作用。     

胆石症对Oddi括约肌的影响

Oddi括约肌是由胆总管及胰管末端大量平滑肌纤维所组成，具有维持胆汁正常排出，防止十二指肠内容物反流等重要功能。目前，Oddi括约肌的结构功能与胆石症的关系日益受到人们的重视。在此，对胆石症对Oddi括约肌的影响作一综述。     

Morphometry of the aging female rat urethra

Muscles in the limbs change with age, but the aging process of urethral muscles is unknown. Therefore, we compared smooth and striated muscle content in the female rat urethra in young (12 month) and old (32 month) animals, using immunochemical techniques. All the striated skeletal fibers at both ages contain slow myosin. Urethral diameter does not change with age (young, 1.44±0.08 mm; old, 1.46±0.10 mm,n=5), nor does the external sphincter width (young, 0.088±0.016 mm; old, 0.080±0.017 mm,n=5). Neither smooth nor skeletal muscle volume in the urethra is changed with age (skeletal: young, 20.72±2.94%; old, 19.95±2.35%. Smooth: young, 22.26±2.98%; old, 26.75±2.35%,n=5). The external striated sphincter is separate and distinct from the pubococcygeal region of the levator ani muscle, but is closely apposed to another layer of longitudinally oriented fibers into the vaginal musculature. The morphometric analysis shows no difference in urethral architecture in aging female rats.EDITORIAL COMMENT: This paper presents a well planned experimental animal model looking specifically at the morphologic characteristics of the aging female rat urethra. Although this information cannot be directly transferred and applied to our knowledge of the aging human female urethra, such research is extremely important. Hopefully, understanding the structure and function of the urethra in other animals will clarify the same in humans. This type of research is critical in finding an appropriate animal model for basic science research in female urology.     

Antitoxin's effect on tetanus toxin induced sphincter pupillae paralysis in the rabbit

Summary The effectiveness of antitoxin in preventing tetanus toxin's blockage of acetylcholine release from the cholinergic nerves of the rabbit iris was tested by injecting purified tetanus toxin into the anterior chamber, and by injecting horse antitoxin at various time intervals either into the anterior chamber, intravenously, or into the anterior chamber and intramuscularly.The results indicate that antitoxin is ineffective in preventing the development of sphincter pupillae paralysis once it is induced by tetanus toxin, prior to appearance of the symptoms.The efficacy of antitoxin treatment depends on the administration of an optimal therapeutic dose.Neither the rate of development, nor the rate of recovery from the maximal pupillary paralysis are altered by antitoxin treatment.The severity, the duration, and the time of complete recovery from the paralysis are directly related to the time antitoxin treatment begins.     

How to diagnose MSA early: the role of sphincter EMG

Summary. Multiple system atrophy (MSA) is a degenerative disease manifesting a combination of parkinsonism, cerebellar, pyramidal, and autonomic (including urinary, sexual and anorectal) dysfunction. It is pathomorphologically defined, but lacks a definitive clinical diagnostic test. In patients with probable MSA, abnormal sphincter EMG, as compared to control subjects, has been found in the majority of patients in all the different forms of the disease in most studies, including patients who, as yet, have no urological or anorectal problems. Patients with Parkinson’s disease (PD) as a rule do not show marked sphincter EMG abnormalities in the first five years of the disease. Thus, abnormal spontaneous activity or marked motor unit potential changes in sphincter muscles are helpful in distinguishing MSA from PD in the first five years after the onset of symptoms and signs, and from pure autonomic failure, as well as from cerebellar ataxias, if other causes for sphincter denervation have been ruled out. EMG does not distinguish MSA from progressive supranuclear palsy. How early in the course of MSA these abnormalities become significant enough to support diagnosis remains to be established by prospective studies.     

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.