32例Oddi括约肌功能障碍患者临床病理分析

目的提高对Oddi括约肌功能障碍的认识,探讨本病的临床病理特征,以提高对Oddi括约肌功能障碍诊治水平.方法对32例因上腹部疼痛无其他原因解释而行内镜下逆行胰胆管造影或内镜下乳头括约肌切开术患者进行了乳头黏膜组织的活检,对活检标本常规石蜡包埋,HE染色,显微镜下观察,记录其病理改变.同时记录经内镜逆行胰胆管造影（ERCP）下乳头黏膜的病理变化.结果内镜下乳头黏膜主要为充血水肿（90.6%）、糜烂（78.1%）、出血（56.2%）等.ERCP见胆总管扩张,合并十二指肠乳头旁憩室者占59.4%.病理组织学表现为乳头黏膜慢性炎症、急性炎症、腺体增生、黏膜下纤维组织增生等.结论Oddi括约肌功能障碍的病因和病理尚不清楚,其乳头组织的病理改变主要为炎性反应,炎症反应在Odd括约肌功能障碍的发病中具有重要的意义,这可能为诊断和治疗本病提供新的靶点.

Sphincter of Oddi Dysfunction: a clinicopathologic analysis of 32 cases

Objective To study the clinical and pathologic features of sphincter of Oddi dysfunction(SOD).Methods Biopsies of 32 cases which were diagnosed as SOD by the clinical characteristics and the results of endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy(EST) were taken by duodenoscopy-biopsy forceps from duodenal epithelium of the papilla of Vater and from ampullary local tissue after sphincterotomy.The specimens obtained were investigated by HE stain.Results Endoscopic lesion,such as the edema and hyperemia of papillary mucosa(90.6%),hemorrhagic erosion(78.1%),localized mucosal bleeding(56.2%) and so on,were observed.Meanwhile,it was also discovered that there were 19 patients(59.4%)with peripapillary diverticula.The histological findings in specimens showed the evidence of chronic and acute inflammation,muscular hypertrophy,fibrosis,or adenocyte hyperplasia.Conclusion Inflammation might play an important role in SOD.It is possibly helpful to the diagnosis and the treatment of SOD.