ObjectiveTo investigate the value of endoscopic sphincterotomy (EST) on treating sphincter of Oddi dysfunction (SOD). MethodsForty-two patients with SOD according to Rome Ⅱ diagnostic criteria were retrospectively summarized. Bile duct residual stone, tumor or biliopancreatic duct obstruction diseases were excluded by B ultrasound, CT, and MRCP examination. Total 42 patients underwent EST. ResultsEST was done successfully in 42 cases, success rate was 100%. Postoperative acute pancreatitis occurred in 5 patients (11.90%), which were cured by 3－7 d conservative treatment. There were no complications of severe acute pancreatitis, digestive tract perforation, hemorrhage, and cholangitis. Follow-up 12-45 months (mean 23.8 months), symptoms of abdominal pain in all cases were improved or relieved, the effective rate was 100%. There were 2 cases treated conservatively because of hyperlipemic pancreatitis. ConclusionEST has become the primary treatment procedure for SOD because of definite outcome, less suffering, safety, less complications, and reproducibility, which are concordant with the requirements of minimally invasive surgery.
ObjectiveTo investigate the option of biliary drainage for surgical management of hepatolithias. MethodsThe clinical data of 146 patients with hepatolithiasis, who were admitted to the First Affiliated Hospital of Anhui Medical University from March 2006 to June 2014, was analyzed retrospectively.These patients were divided into biliary enteric drainage group and T tube drainage group according to the function of sphincter of Oddis.The intra-operative related data, postoperative complications, and long-term efficacy were compared between two groups. Results①The two groups were comparable in terms of gender, age, body weight, preoperative liver function, preoperative symp-toms and signs, preoperative biochemical index, calculus distribution, preoperative complications (P > 0.05).②There were no significant differences of the hepatolobectomy rate, intraoperative blood loss, intraoperative blood transfusion, times and time of hepatic portal occlusion, bile culture positive rate, hospital stay and hospitalization expenses between two groups (P > 0.05).But the operation time of the biliary enteric drainage group was significantly longer than that of the T tube drainage group (P < 0.001).③The total complications rate and specific complication rate were not signifi-cantly different between two groups (P > 0.05).④The stone instant clearance rate of the biliary enteric drainage group was significantly higher than that of the T tube drainage group (P=0.031).But the stone final clearance rate was not significantly different between two groups (P=0.841).⑤The postoperative quality of life was not significantly different between two groups (Excellent and good:P=0.560;Poor:P=0.560).The rates of stone residual, recurrence, mortality and canceration were not significantly different between two groups (P > 0.05). ConclusionThe biliary drainage for surgical management of hepatolithias is selected according to the function of sphincter of Oddi.Biliary enteric drainage and Roux-en-Y anastomosis are firstly selected for patients with the loss of function of sphincter of Oddi.
ObjectiveTo investigate the relationship between the changes of nerve cells in sphincter of Oddi and acute pancreatitis. MethodsThe rabbit models of acute pancreatitis were prepared by using sodium taurocholate perfusion. Immunohistochemical method was used to detect the expressions of nitric oxide synthase (NOS) and vasoactive intestinal peptide (VIP) in neurons of the sphincter of Oddi. ResultsIn the control group, (45.83±2.17)% of myenteric neurons were NOS-positive, (52.46±2.47)% of myenteric neurons were VIP positive, and (22.73±1.95)% of myenteric neurons were NOS and VIP double positive. In contrast, (11.26±0.93)% of myenteric neurons were NOS-positive and (28.62±2.83)% of myenteric neurons were VIP positive in SAP group, which were significantly less than those of control group (P < 0.01). ConclusionsThe sphincter of Oddi of normal rabbits is rich in VIP and NOS positive neurons. The significant reduction of NOS-positive and VIP-positive neurons when SAP, which may be the reason of decreased the activities of the sphincter of Oddi.