不同术式对Oddi括约肌功能影响的对照研究

doi:10.3969/j.issn.1005-6483.20240780

摘要/Abstract

摘要： 目的对比两种术式(十二指肠乳头成型术、十二指肠乳头小切开+大球囊扩张术)对胆总管结石病人Oddi括约肌功能的影响。方法 2021年1月～2022年12月行内镜下逆行胰胆管造影(ERCP)取石术的胆总管大结石病人64例，应用抽签法将随机分为两组，A组32例，行十二指肠乳头成型术，B组32例，行十二指肠乳头小切开+大球囊扩张术。术前、术后即刻及术后1个月分别进行十二指肠压力测量(Oddi括约肌基础压力、最大收缩压力、收缩频率)，观察各测量指标变化，并比较两组的近期及远期并发症发生情况。结果两组术后即刻及术后1个月的Oddi括约肌基础压力、最大收缩压力及收缩频率呈先降后升趋势，且均较术前低，差异有统计学意义(P<0.05)。两组术后即刻的Oddi括约肌基础压力、最大收缩压力及收缩频率比较，差异均无统计学意义(P>0.05)。A组术后1个月的Oddi括约肌基础压力、最大收缩压力及收缩频率分别为（21.12±4.08）mmHg、（113.60±12.07）mmHg和（6.10±0.96）次/分钟，B组分别为（16.28±1.64）mmHg、（104.19±19.25）mmHg、（5.68±1.02）次/分钟，A组均高于B组，差异均有统计学意义（P<0.05）。A组术后1周、术后6个月及术后12个月的气体反流发生率分别为6.25%、3.13%、0，B组分别为21.88%、15.63%、12.50%，A组钡剂反流发生率分别为3.13%、0、0，B组分别为12.50%、9.38%、6.25%，两组比较差异有统计学意义（P<0.05）。两组术后的近期及远期并发症总发生率接近(34.38% 和 31.25%），两组比较差异无统计学意义（P>0.05)。结论相比十二指肠乳头小切开+大球囊扩张术，十二指肠乳头成型术更有助于Oddi括约肌功能的恢复，且该术式操作简单，不会增加术后并发症发生风险。

关键词: Oddi括约肌, 十二指肠乳头成型术, 十二指肠乳头小切开术, 胆总管结石

Abstract: Objective To compare the effects of two surgical methods (duodenal papillary reconstruction and small duodenal papillary incision+large balloon dilation) on Oddi’s sphincter function in patients with common bile duct stones.Methods From January 2021 to December 2022,64 patients with large common bile duct stones underwent endoscopic retrograde cholangiopancreatography (ERCP) stone removal surgery,which were randomly divided into two groups using a lottery method (32 cases each).Group A underwent ECPP,while Group B underwent limited EST plus EPLBD.Before the procedure,immediately after procedure,and one month after procedure,duodenal pressure measurements (Oddi sphincter basal pressure,maximum systolic pressure,and systolic frequency) were conducted to observe changes in various measurement indicators,and to compare the incidence of short-term and long-term complications between the two groups.Results The basal pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter in both groups immediately after the operation and one month after the operation showed a trend of first decreasing and then increasing,and were all lower than those before the operation,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the basic pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter immediately after surgery between the two groups (P>0.05).One month after the operation,the basal pressure,maximum systolic pressure and systolic frequency of the Oddi sphincter in group A were (21.12±4.08) mmHg,(113.60±12.07) mmHg and (6.10±0.96) times/minute,respectively.The values in group B were (16.28± 1.64) mmHg,(104.19±19.25) mmHg,and (5.68±1.02) beats/minute,respectively.The values in group A were all higher than those in group B,and the differences were statistically significant(P<0.05).The incidences of gas reflux in group A at 1 week,6 months and 12 months after surgery were 6.25%,3.13% and 0 respectively,while those in group B were 21.88%,15.63% and 12.50% respectively.The incidences of barium reflux in group A were 3.13%,0 and 0 respectively,and those in group B were 12.50%,9.38% and 6.25% respectively.There were statistically significant differences between the two groups (P<0.05).The total incidence of short-term and long-term complications after surgery was close (34.38% and 31.25%),and there was no statistically significant difference between the two groups (P>0.05).Conclusion Compared with limited EST plus EPLBD,ECPP is more helpful for the recovery of Oddi’s sphincter function,and this surgical procedure is simple to operate without increasing the risk of postoperative complications.

Key words: Oddi sphincter, duodenal papillary reconstruction, small duodenal papillary incision, common bile duct stones

陈至操, 许哲. 不同术式对Oddi括约肌功能影响的对照研究[J]. 临床外科杂志, 2025, 33(4): 397-400.

CHEN Zhicao, XU Zhe. A comparative study on the effects of different surgical techniques on the function of Oddi's sphincter[J]. JOURNAL OF CLINICAL SURGERY, 2025, 33(4): 397-400.

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