| 引用本文： |
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张晓东,关亚萍,傅 晓,等.乳头括约肌切开术联合乳头扩张术治疗胆总管扩张型可疑胆源性Oddi括约肌功能障碍患者的疗效分析[J].同济大学学报（医学版）,2020,41(6):760-765. [点击复制]
- ZHANG Xiao-dong,GUAN Ya-ping,FU Xiao,et al.Efficacy of endoscopic sphincterotomy combined with endoscopic papillary balloon dilation in treatment of suspected biliary sphincter of Oddi dysfunction in patients with dilated common bile duct[J].同济大学学报（医学版）,2020,41(6):760-765. [点击复制]
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| 摘要: |
| 目的观察乳头括约肌切开术（endoscopic sphincterotomy, EST）联合乳头扩张术（endoscopic papillary balloon dilation, EPBD）治疗罗马Ⅳ标准中胆总管扩张型可疑胆源性Oddi括约肌功能障碍（sphincter of Oddi dysfunction， SOD）患者的临床疗效。方法回顾性研究2015年1月—2018年12月同济大学附属东方医院诊治的61例胆囊切除术后符合罗马Ⅳ标准中胆总管扩张型可疑胆源性SOD诊断患者临床资料。所有患者均有胆源性腹痛和胆总管扩张，但无明显肝功能异常并排除胆总管结石、肿瘤等可疑病变。所有患者均给予内镜逆行性胰胆管造影（endoscopic retrograde cholangio-pancreatography， ERCP）治疗，其中31例患者给予内镜下乳头括约肌切开术（endoscopic sphincterotomy， EST）治疗（EST组），30例患者给予EST联合内镜下乳头球囊扩张术（endoscopic papillary balloon dilation， EPBD）治疗（联合组）。观察患者治疗后腹痛缓解、术后1年影像学胆总管扩张改善及腹痛复发等状况。结果所有入组患者ERCP均获得成功，无重症急性胰腺炎、消化道出血、消化道穿孔等严重并发症。EST组患者术前、术后1周、术后1年腹痛评分分别为6.4±0.9、4.0±1.1、5.1±1.1，联合组患者分别为6.7±0.7、3.4±0.5、4.5±1.0，两组术后、术后1周、术后1年均有效缓解腹痛症状（P<0.05），但联合组疗效优于EST组（P<0.05）。术后EST组、联合组分别有3例（9.7%）、5例（16.7%）并发轻症急性胰腺炎或高淀粉酶血症，分别有1例（1/31，3.2%）、2例（2/30，6.7%）并发胆道感染，两组间差异均无统计学意义（P>0.05）；术后1年EST组和联合组分别有12例（12/31，38.7%）、4例（4/30，13.3%）患者腹痛复发到术前程度，联合组腹痛完全复发率明显低于对照组（P<0.05）。术前及术后1年胆总管最大直径EST组分别为1（3.2±1.4）mm、（12.7±1.2）mm，P<0.05；联合组分别为（13.0±1.2）mm、（10.9±1.2）mm，P<0.05；联合组明显优于EST组。结论EST联合EPBD更有效缓解胆囊切除术后罗马Ⅳ标准中胆总管扩张型可疑胆源性SOD患者腹痛症状、降低腹痛完全复发率、改善胆总管扩张状况。 |
| 关键词: 内镜逆行性胰胆管造影 乳头括约肌切开术 内镜下乳头球囊扩张术 胆源性Oddi括约肌功能障碍 临床疗效 |
| DOI：10.16118/j.1008-0392.2020.06.013 |
| 投稿时间：2020-08-20 |
| 基金项目: |
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| Efficacy of endoscopic sphincterotomy combined with endoscopic papillary balloon dilation in treatment of suspected biliary sphincter of Oddi dysfunction in patients with dilated common bile duct |
| ZHANG Xiao-dong,GUAN Ya-ping,FU Xiao,WANG Jing,SONG Sen-tao,SUN Yan,LI Jun,YUAN Qiong-ying,ZHU Feng |
| (Dept. of Gastroenterology, East Hospital, Tongji University School of Medicine, Shanghai 200120, China) |
| Abstract: |
| ObjectiveTo evaluate the therapeutic effect of endoscopic sphincterotomy(EST) combined with endoscopic papillary balloon dilation(EPBD) in treatment of suspected biliary sphincter of Oddi dysfunction(SOD) in patients with dilated common bile duct after cholecystectomy. MethodsA retrospective study was conducted on 61 patients diagnosed as suspected biliary SOD with dilated common bile duct after cholecystectomy by ROME Ⅳ criterion in our hospital from January 2015 to December 2018. All patients were treated with ERCP, including 31 cases treated with EST(EST group), and 30 cases treated with EST and EPBD(combined group). The relief of abdominal pain one week and one year after ERCP, the complete recurrence of the abdominal pain and the improvement of dilation of common bile duct one year after ERCP were observed. ResultsERCP was successful in all patients without severe complications including severe acute pancreatitis, gastrointestinal bleeding or perforation. Abdominal pain scores before ERCP, one week and one year after ERCP were 6.4±0.9, 4.0±1.1 and 5.1±1.1 in the EST group, and 6.7±0.7, 3.4±0.5 and 4.5±1.0 in the combined group, respectively. The relief of abdominal pain one week and one year after ERCP was significant in both groups(P<0.05) while the combined group was superior to the EST group(P<0.05). There were 3 cases(3/31,9.7%), 5 cases(5/30,16.7%) complicated with mild acute pancreatitis or hyperamylase, 1 case(1/31,3.2%) and 2 cases(2/30,6.7%) complicated with biliary infection after ERCP in the EST group and the combination group, respectively(P>0.05).The complete recurrence of the abdominal pain one year after ERCP was 12 cases(38.7%) and 4 cases(13.3%) in the EST group and the combined group respectively(P<0.05). The maximum diameter of common bile duct before and one year after ERCP was 13.2±1.4mm and 12.7±1.2mm in the EST group(P<0.05) and 13.0±1.2mm and 10.9±1.2mm in the combined group(P<0.05). The combined group was significantly superior than the EST group(P<0.05). ConclusionEST combined with EPBD is more effective in relieving the symptoms of abdominal pain, reducing complete recurrent abdominal pain and improving dilated common bile duct for suspected biliary SOD patients with dilated common bile duct after holecystectomy. |
| Key words: endoscopic retrograde cholangio-pancreatography endoscopic sphincterotomy endoscopic papillary balloon dilation sphincter of Oddi dysfunction clinic effect |
