32例胆总管末端良性狭窄的诊治体会

32例胆总管末端良性狭窄的诊治体会 2006???[1??6?k ?l?o???????]?O?E???b?b?B?L?x?????????-?i?????? ???b???d?x?????5?????G???5?????????d?0x2?????i???? ???????O?G???????y?k?b?b?z???x???N?T??eR?????3???-?i ???.??eM?????????O?????????????????O?O?????????????? ?????????x???????H??x0?????d?B?s?n?????????O?=???y?k ?B???B?k?x????x0?l?o???????]?O???9?????????????p?B?- ?n?????y???r?????k???????O???????Vx2?????%?V?d?J?O?? ?O?%???????P?????O?B?????-????x0???9?n?E??1983???? ???h????32?????y???r?????p???????o?????????????? ?8?????7x0 1?????i???? 1.1???[????????32???]?O?u?p9???O???p23???O?u'h??= 1'h2.55x0????39??71???O???L56.3??x0???????????????3??7 ???O?????3?????????????-?i19???O?????p???????-?i3 ???O???p??????3??x0?????????????????.???dOddi???? ???=?3???(???-7???O???????%?V?-14???O???????7?????? ?3???-(EST)8???O????????3??x0?????????L?=?d?O?7???? ?5???d?0x2?????????O?o?=????13??(40.6%)?O????13?? (40.6%)?O?l???????o?N?9?G?W???????L??6??(18.8%)?O?o SGPT??AKP?L??21??(65.6%)?O?N??????????12?? (37.5%)x0 1.2???????????.1?=B???B?????????L??B???????O?=?d?O ?7???????y?????e?O?G?????G?????L???ex0?.2?=PTC?B6???( ????PTC?O?Y?w?e???X?d?????G???E?????V???3??x0?.3?= R?B???O?Y?w???y???r???d???p????x0?.?=T?GMR?B ???O?Y?w?????G?????d?O?7?????ex0 1.3???-3???????????????7?????G???-x0???-?????L?? ?????e???O?Y?w?e???X?d?????G???E?????V???3???O???y?? ?r???=?d?O?7????????????x0???????y???r???L?d???B??3 ??Bakes's?????????G/??8?????W??x0?????????????????3 ???(???-7???O???????%?V?-14???O???????7???????3?? ?-(EST)8??x0 2???? ?[??32???L?????????O????????2~22??x0???41???O ?V???3???41???O???.28???O????1???O?t?????-??3???? ???b???d?n??x0 3???? 3.1???????k?8???y???r???-?3???y?????V???3?????? ???O????1.7??3.0cm?O?????????????????9???O?B?i?y?????? ?O???????V???3???[?????i?????????V???3?????o?O???? ???????o?.Papillavater?=x0?B?b???????????B??8mm?????? ???O???4??3mm???????w???y???r???????.?9???V???3?? ???o?????=?O????????x2??????????????????x2???????Y?d ?J?O???O?%?????????o??????x0 ???????????????n??????????x2???????????????o?? ???????(?O?????k???????k?????-??x0?????????????????? ?)???????O?l?????5???????????????V???3???O???y?????? ?-?8???V?????????2?x?V???3???O???G???k?????8???V?? ???x?????O?D???V???3?????8?V??????[1] x0 3.2???????????w?O???y???r?????p?????????-?n???-?? ?????????????????????G?????????????????x???????~?N ??x0?????O?l?????w?h???N?5?=???9???????~???????????? 32?????y???r?????p?????????????B ?o???O?e???g?O???????O?????w ?.?5???0?[?????E?y???????8???O?5??200940?= x(????xE?????w?????????y???r?????p???????????O??????????????????x0?????????p?8???E??1983???????h?? ??32?????y???r?????p???????o???????????O?????3???-?i7???O?????3?????????????-?i19???O?????p???????-?i3 ???O???p??????3??x0?????????????????3???(???-7???O???????%?V?-14???O???????7???????3???-(EST)8???O3?????? ???-x0?????-?i???????41???O?V???3???41??x0???.28???O????1??x0???-?H?????4x0?????o???y?k???????????y?? ?r?????p??????????x0 x(???;??xE???y??????;????;?G?????- x(?]???8????xER575.7x(???;?3???2xEAx(?????G??xE1673-7555[2006]06-4-02 ExperienceinDiagnosisandTreatmentofBenignStenosisattheend ofCommonBileDuct x(ABSTRACTxEObjectiveToimprovetheunderstandingofbenignstenosisattheendofcommonbileductforcorrect diagnosisandtreatment.MethodsTheclinicaldataof32casesofbenignstenosisattheendofcommonbileductthatwere treatedinourhospitalsince1983wereretrospectivelyanalyzed.7patientshadahistoryofcholcystectomyand19withahistory ofcholecystectomypluscholedocholithotomy.3operationsduetobiliarypancreatitis,andother3casesduetochronicpancreatitis. Sevenpatientsunderwenttransduodenalsphincterplasty(TDSP),andbiliary-jejunalinternaldrainageto14.Eightpatients underwentendoscopicpapillosphincterotomy(EST).ResultsAftertheoperation,transientbileleakagewasfoundin2,duodenal fistulawasfoundin1.Twenty-eightpatientswerecuredand1died.Theoperationresultwasexcellent.ConclusionsDoctors shouldimprovetheunderstandingofbenignstenosisattheendofcommonbileduct. x(KEYWORDSxECommonbileductdiseases;Stenosis;Surgeryoperative 4 ECP94CCP 17 ChinaPracticalmedical,November.2006?OVol.1?ONo.6 ??????????[2?O3]?O???B?.1?=???????????????????.Sphincterof Oddistenosis?OSOS?=?O?.2?=???????????????????????.Sphincter ofOddidyskinesiaSOD?=x0???9?-???????????0?b?O?????? ???0?b?????-?n?????p?????G?????G?%?????8?G???????? ?????????O?b?b?i???????O?????????e?(???o???~?O?????? ?-?]???~?G???????????0?k?????=??x0?O?????????????? ?????????-???????????w???????L?p?????y???O???????? ???n?????????C?O???p?G?9???????%???O???????????????? ???????????z???????????????????????p?5??x0 ?[???????????L?=?????p???(???p???V???k?w?????? ?e???lx0?=???y???r????????19??x0?????p???????-?i3 ???O???p??????2??x0?m?.?5???????w?hx0 3.3???????????y???r?????p?????N?%?????????P?o?? ?????O???????=?B???-???????????????O?????o????x2???? ???Cx2???????????????????????3???-?i???.???????O???? ?J?5???????E???????????????5???d??x0?n??????x2?o???? ??x2?????????????????????????w?????0?p?O?-?????????y ???r?????p?????????i???????????T???O?=???i???p???y ???????rx0???????O???N???f??????x2X???f???????-x2???? ??????x2???r?-?????????-???????????l?O?????y???r???? ?p?????????????p?p????x0?E?????w?O?????(?i?G?i?????? ?????5?????????G???????O?G?o?=????x2???????????????? ?0?b?O???r?-?=???y??????x2?????????????-???????d???p ???????????????O???w???c???y?k?????6?????y???r???? ?p????????x0 ???????????????=?B?.1?=?????~?p?????BCTx2MRIx2B??x2 ??????????x2????eT???????e??????x0?.2?=???~?p?????=?B ERCPx2SOM?.?????????????????????????-?=??x0 ERCP???????x?????????????????????O?B??ERCP?? ???w?r?????O?????G?H?v?0?b?e?(?????y?O?:??????ERCP ?????????4???????l?????????????O?????lERCP?7???? ???Y???????G?????o?O?G?????????bx0?lERCP?7?e???X?? ??????????45?8?????w?=???????????????O???????????? ???3????????x0ERCP???w???-?=?????????????8???k?? ??????x0 SOM?-???????????y???r?????????=???z???????? ??x0??????????????????,?????????w???N???i?Y?L???? 40mmhg(5kpa)???5?O?????i??????????x2?????Gx2?????????? ?G???-???~?=??x0???????????????????????B~????N?h?v?? ???????B???8??????7?s???w?0?b?C~????L?p???N???L???B ?????L?p???N?h?v???L????40mmhg?O?????????A???y???O ?d?????????????b?C~??8???p?h?v???B?.'?50%?=?C~??????h ?v?e?????????B???b?????7?O?????h?v?e???h??????????? ?????????????O???????????N???????O???N?h?v?????????O ?OSOD?9?O?????=???1?????h?v?e?i?O?????????N???L???O ???N?h?v????????x0 ????????????????[4] ?O?V???3?????o???????????????? ???????????????.???????????G?O?????=?7?P?????3???? ???????B?.?=?????????N??'?;?.?=???????h?v?e?= ???????????????C?.3?=R?Y?w???y?????e?X?????X???? ????x0 ???.?[???O?N?=?????L??B???????O?=?d?O?7???????y ?????e?O?G?????G?????L???ex06????PTC?????O9???n ERCP?????????OCT?GMRCP???x?????917??x0?n???[?? ?????=???O?[???????t???????????????????????????-x0 3.4???????y???r???????????????K?-?????????????? ?????????V?????????????y???O?=????x2?????7?????????- ?=??????????x0 ?????w???O???=?H???????y???r?????????????O?????? ???????????????H??x0 ?[??32???]28?????.?O3???t?????-???????b???d?? ??x0?????E?????w?O???????????????????G???-?w???O?)?- ?]???b?????????e???O???8???????????????????O?????e?? ?X?d???G???E?????V???3???OX???L?Y?w???y???r?????? ????x0 ???????????????????????3???-(EST)??20?G??70?? ?????????l?O?????y???r???????-???????????????????O?? ?A???-?????d???????-?????O?????l???7?8?V???3?????? ???????3???O?d???k???4?O???l?f?????H???3?????o???? ???O?d?T???(???????O?????????V?????b?k?8?B???O???2?? ?n????????????x0?~???0?l???????c???O???-?=?????????? ????x0?j????EST???=???????????????E?O???H???????A ??x0?[??8????EST?L?????????H??x0 ???????????????3???(???-?O?-???????w?????????-?O ?o?????l???????O?m?.???V?????b?k?8?B???O???x???????? ???N???????y?O?:?=???d???????x???2?????8?V???V???3 ???4?O???????k?O??????????x0?????y???r?????????????[ ?-?4?d???????????O???=?l?????y?.?-x0 ???????%?V?-?????[?-?4?9???B???y???V???3???y?. ?-?O?????????????V???3???y?.?-?O???????4?y?.?-?O???? ????Roux-Y?y?.?-x0???]???i?9?w?A?O?A???-[5]?B~??t???? ???i?????y?.?????????????.??x0~????????????k???????O ?????6???p?O???l?????????????G?????%?Vx0~??y?.???p?4 ?d?????h?O???e???O?d?T?%??????x0?[??14???????????%?V ?-?O?H?????4x0 ?D???????y???r?????????????????H???O???????x?B?- ?????k?8???1?????????????4???O?????-???????y???r?? ?????????=???????????~???C?-?]???k?????O???2???-?]?? ???e???O?D?????4????x0?????=?????-???4?-???????k???H ?????;?O?????????????B?s???-??????x0 ???6???; [1]BeckerJM.physiologyofmotorfunctionofthesphincterofoddi. SurgclinNorthAm1993,73:1291-309. [2]ChuttaniR,Carr-LockeDL.pathophysiologyofthephincterof oddi.SurgclinNorthAm1993,73:1311-22 [3]ToouliJ.Sphincterofoddi.Gastroenterologist1996,4:44-53. [4]?????w?O??????.?G????????????????????.?P??:???E???y???H ?Y?O2003.468-475. [5]?????O?????E?????y?.?-?????????l?]?????B?????G???? ??5?O?B555 5 140mmHg2 ECP .. .200412-1.