Oddi括约肌在肠胆返流中作用的研究

目的放射性核素检查判断T型管引流术后病人是否存在肠胆返流，然后行经胆道镜Oddi括约肌测压判断其是否存在Oddi括约肌运动功能不良，并检测这些病人血浆胃动素及血清胃泌素水平，从而探讨肠胆返流与Oddi括约肌运动功能及胃肠肽类激素之间的关系。方法胆道术后留有T型管病人123例，使用放射性核素^99mTc-DTPA判断是否存在肠胆返流，并根据结果将病人分为返流组及对照组，检测其中45例病人空腹血浆胃动素、血清胃泌素水平，并取12例正常人血浆及血清作为对照组，随机选取53例使用胆道镜测量病人的十二指肠压（DP），Oddi括约肌基础压（SOBP）、收缩波幅（SOCA）、收缩频率（SOF）、收缩间期（SOD）及胆总管压（CBDP）。结果123例行胆道取石T型管引流术后的病人中有44例检测到十二指肠胆道返流（35．8%），返流组Oddi括约肌基础压（SOBP）、收缩波幅（SOCA）、胆总管压（CBDP）显著低于对照组（P〈0．001）。逆流组血浆胃动素，血清胃泌素水平明显低于无逆流组及对照组（P〈0．01）。血浆胃动素与SOBP，血清胃泌素与SOBP及CBDP呈正相关。结论胆管色素结石病人存在着肠胆返流现象，其发生率可达1/3左右。这类病人的Oddi括约肌功能存在异常，胆道压力测定和血中胃泌素及胃动素均存在较无返流组低的状态。这提示Oddi括约肌异常可能是原发性胆管色素结石发生的重要因素之一。

Role of sphincter of Oddi in duodenal-biliary reflux

Objective To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux by measuring amounts of radioactivity of Tc99m-labeled diethylene triamine pentaacetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility by determining the level of plasma motilin and serum motilin of the patients, and to discuss if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides. Methods A total of 123 patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of Tc99m-DTPA in the bile. Of them, 53 were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP), common bile duct pressure (CBDP) were determined and analyzed. The levels of plasma motilin and serum gastrin in 45 patients and 12 healthy volunteers were measured with radioimmunoassay. Results There were 44 patients with duodenal-biliary reflux (35. 8%). SOBP, SOCA and CBDP were much lower in the reflux group than that in the control group (P<0. 001). The level of serum gastrin and plasma motilin of the reflux group were much lower than that of the control group(P<0. 01). There is positive correlation between the level of plasma motilin and SOBP while the levels of serum gastrin were positively correlated with SOBP and CBDP. Conclusions There are about 35. 8% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the levels of plasma motilin and serum gastrin decreased. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux.