胆管型Oddi括约肌功能障碍的临床进程:内镜括约肌切开术和功能性消化不良为其影响因素。

时间:2019-11-08 作者:翻译 胡越 审校 张立 点击:243次
Clinical course of biliary-type sphincter of Oddi dysfunction: endoscopic sphincterotomy and functional dyspepsia as affecting  factors
胆管型Oddi括约肌功能障碍的临床进程:内镜括约肌切开术和功能性消化不良为其影响因素

Abstract
BACKGROUND AND STUDY AIMS:
The objective of this study was to clarify the effectiveness of treatment selection for biliary-type sphincter of Oddi dysfunction by severe pain frequency and the risk factors for recurrence including the history of functional gastrointestinal disorder.
摘要
背景与研究目的:
这项研究的目的是通过严重疼痛的频率和复发危险因素(包括胃肠功能障碍病史)来阐明对胆管型Oddi括约肌功能障碍的治疗有效性。
 
PATIENTS AND METHODS:
Thirty-six sphincter of Oddi dysfunction patients who were confirmed endoscopic retrograde cholangiopancreatography enrolled in this study. Endoscopic sphincterotomy was performed for type I and manometry-confirmed type II sphincter of Oddi dysfunction patients with severe pain (⩾2 times/year; endoscopic sphincterotomy group). Others were treated medically (non-endoscopic sphincterotomy group).
病人和方法:
本研究纳入了36例经内镜逆行胰胆管造影证实的Oddi括约肌功能障碍患者。对I型Oddi功能障碍患者和经测压法测量确认的伴有严重疼痛的II型Oddi括约肌功能障碍患者进行内镜括约肌切开术(⩾2次/年;内镜括约肌切开组)。其他患者接受药物治疗(非内镜括约肌切开组)。
 
RESULTS:
The short-term effectiveness rate of endoscopic sphincterotomy was 91%. The final remission rates of the endoscopic sphincterotomy and non-endoscopic sphincterotomy groups were 86% and 100%, respectively. Symptoms relapsed after endoscopic sphincterotomy in 32% of patients. Patients in the endoscopic sphincterotomy and non-endoscopic sphincterotomy groups had or developed functional dyspepsia in 41% and 14%, irritable bowel syndrome in 5% and 14%, and gastroesophageal reflux disorder in 14% and 0%, respectively. History or new onset of functional dyspepsia was related to recurrence on multivariate analysis. The frequency of occurrence of post-endoscopic retrograde cholangiopancreatography pancreatitis and post-endoscopic retrograde cholangiopancreatography cholangitis was high in both groups. Two new occurrences of bile duct stone cases were observed in each group.
结果:
内镜括约肌切开组的近期有效率为91%。内镜括约肌切开组和非内镜括约肌切开组的最终缓解率分别为86%和100%。内镜括约肌切开组出现术后症状复发的占32%。内镜括约肌切开组和非内镜下括约肌切开组患有或发展为功能性消化不良的分别占41%和14%,患肠易激综合症的占5%和14%,患胃食管反流障碍的分别占14%和0%。多因素分析中,新发功能性消化不良或以往存在病史与Oddi括约肌功能障碍症状复发有关。两组ERCP术后胰腺炎和ERCP术后胆管炎的发生率均较高。每组中均观察到有两例新发胆总管结石。
 
CONCLUSION:
According to the treatment criteria, endoscopic and medical treatment for biliary-type sphincter of Oddi dysfunction has high effectiveness, but recurrences are common. Recurrences may be related to new onset or a history of functional dyspepsia.
 
结论:
根据治愈标准,内镜和药物治疗Oddi胆管括约肌功能障碍均有较高的疗效,但复发很常见。复发可能与新发的功能性消化不良或以往存在病史有关。