Oddi括约肌-从切开到修复.pdf

曾建平，等．Oddi括约肌：从切开到修复 209 述评 Oddi括约肌：从切开到修复 曾建平，董家鸿 (清华大学附属北京清华长庚医院肝胆胰中心，北京102218) 摘要：Oddi括约肌是控制胆胰管通道的阀门，对于维护胆胰管正常生理功能具有不可替代的作用。无论是括约肌成形还是切 开术，均可不同程度的破坏Oddi括约肌的功能，造成术后十二指肠液的反流和胆汁细菌污染，增加复发性胆总管结石、反流性胆管 炎甚至胆管癌的风险。因此，临床医师应重视保护Oddi括约肌的结构和功能。基于笔者的经验，对于括约肌已被医源性损伤的患 者，在肝外胆道可保留的前提下，均应联合经十二指肠括约肌修复术以恢复Oddi括约肌结构的完整性，减少其功能缺失继发的胆胰 管并发症。 关键词：括约肌切开术，内窥镜；奥狄括约肌功能障碍；胆道疾病；胰腺疾病；手术后并发症 中图分类号：R657．4；R657．5文献标志码：A 文章编号：1001—5256(2017)02—0209—04 The of incision Oddi：fromto sphincter repair ZENG Universi一 Jianping，DONG Jiahong．(Department∥’HepatopancreatobiliarySurgery，BeqingTsinghuaChanggungHospital，Tsinghua 102218，China) 耖，Be彬ng ofOddiisavalvethatcontrolsthe ductand an rolein normal Abstract：The sphincter biliopancreaticplaysirreplaceablemaintainingphysi— functionsofthe and cause of tothe ological biliopancreaticduct．However，sphincteroplastysphincterotomymay varyingdegreesdamage functionofthe of in refluxofduodenMfluidsandbacterialcontaminationinbileand furtherresult sphincterOddi，whichmay postoperative increasetherisksofrecurrentcommonbileduct even stones，refluxcholangitis，and physicians should thestructureandfunctionofthe ofOddi．Basedonour the thatthe bileduct protect sphincter experience，underpremise extrahepatic canbe with ofthe ofOddicanbetreatedwithtransduodenal torestorethe preserved，patientsiatrogenicinjury sphincter sphincteroplasty structural ofthe ofOddiandreduce duct tolossoff