研究Oddi括约肌肌电活动的实验动物模型的建立

目的探讨将家兔用于研究Oddi括约肌肌电活动的实验动物模型的可行性和稳定性。方法对不同条件下的家兔采用双极金属钩状电极采集其肌电活动信号，经放大、滤波及计算机处理后记录其大小及波形。结果不同条件下的家兔Oddi括约肌的肌电活动在波形、频率、强度等方面均有明显的不同，具有明显的规律性。重复实验可得到相同的结论。结论家兔是研究Oddi括约肌肌电活动较为理想的动物，具有价格低廉、来源广泛、信号稳定等优点。使用双极金属钩状电极可以稳定地采集到在体的Oddi括约肌肌电活动信号，这为今后广泛、深入地研究Oddi括约肌肌电活动搭建了一个技术平台。     

犬Oddi括约肌肌电的研究

目的探索能准确稳定记录犬Oddi括约肌(sphincter of Oddi,SO)肌电活动的新方法,并对记录到的肌电波形进行初步分析。方法用自行研制的黏膜接触式电极记录30只犬SO肌电活动,同时记录十二指肠和胃的肌电活动,分析SO肌电波形的规律以及和胃十二指肠肌电的关系。结果用我们的方法可以记录到犬SO的快波和慢波,同步记录以及切离实验证实记录到的波形是犬的SO肌电而不是来自十二指肠和胃。结论犬的SO肌电记录是可行的,犬SO快波和慢波的发现将对SO功能研究提供一个新的平台。     

Oddi括约肌肌电活动的基本方式

目的 探讨家兔Oddi括约肌(sphincter of Oddi,SO)肌电活动的基本方式及其生物学意义.方法 32只家兔随机分为4组.第1组(n=8)为空腹组;第2组(n=8)为进食组,空腹18 h后经胃造瘘管注入50 ml牛奶;第3组(n=8)为Nardi test激发实验组,静脉注射1 mg吗啡和1 mg新斯的明;第4组(n=8)为神经阻断组,记录空腹家兔肌电活动30 min后静脉给予山莨菪硷1 mg;两对钩状双极金属电极通过浆膜层分别置于SO及十二指肠,使用RM6240多道生理信号采集处理系统同时记录每一组家兔SO及十二指肠肌电活动,连续记录SO肌电活动120～150 min.结果 空腹状态下家兔SO肌电表现为规律的、单发性的SPSO;进食后家兔SO肌电活动表现为规律的、间断的MASO;Nardi test激发实验后SO肌电活动表现为数个长时间、不间断的SPSO组成的肌电串;阻断神经节后胆碱能神经元后SO肌电活动规律随即消失,120 min后SPSO逐渐恢复到空腹状态.结论 家兔SO肌电活动存在4种基本形式,即空腹状态下SO保持一定基础紧张性的基本张力波;进食后SO开始蠕动将胆汁排入十二指肠的蠕动波;Nardi test激发实验后SO处于持续关闭状态的痉挛波;阻断胆碱能神经元后SO处于松弛状态的舒张波.提示SO并非仅仅存在"非开即闭"两种形式.这对今后有关SO基础研究和临床治疗均具有理论指导意义.     

黏膜接触电极在家兔Oddi括约肌肌电测量中的应用价值

目的 探讨适合Oddi括约肌（sphincter of Oddi,SO）肌电测量的新方法.方法 两组各15只家兔分别用黏膜接触电极（contact electrode on mucosa,CEM）和浆膜钩状电极（chorion claw electrode,CCE）测量SO肌电活动;另外6只家兔同时使用两种电极同步测量.结果 CEM测量SO肌电成功率高,创伤小,而且记录到的家兔SO肌电波形和CCE相比没有明显的差别.结论 CEM是一种很有价值的测量SO肌电活动的新方法,将来可能用于人体SO功能的研究,为人体内镜诊断SO功能提供了一个新方法.     

犬双侧迷走神经干切断术对Oddi括约肌肌电的影响

目的 研究双侧迷走神经干切断术对Oddi括约肌（SO）肌电的影响。方法 禁食16～18h（可自由饮水），成年杂种犬麻醉后，实验组行膈肌水平双侧迷走神经干切断术加幽门成形术，对照组仅行幽门成形术。手术后8周行SO肌电记录（SOE）。结果 实验组慢波幅度明显升高，快波未观察到显著性变化。结论 双侧迷走神经干切断术对SO肌电产生明显影响。     

肝胆管结石患者胆总管切开取石术后Oddi括约肌肌电的研究

目的 研究肝胆管结石患者胆总管切开取石术后Oddi括约肌(SO)肌电的特点,旨在寻找临床研究、检测SO功能的新方法.方法 对2010年1月至10月在第三军医大学西南医院复诊的33例行胆总管切开取石术的肝胆管结石患者经T管窦道胆道镜辅助行SO压力与肌电检测,根据SO测压结果将33例患者分为低压力组、正常压力组及高压力组,比较各组患者SO峰电位丛(SOSB)幅值、频率和持续时间.结果 低压力组、正常压力组、高压力组患者分别有14、13、6例,平均SO基础压力分别为(3.1±1.2)、(18.5 ±7.6)、(39.8 ±4.8)mm Hg(1 mm Hg=0.133 kPa).低压力组、正常压力组、高压力组患者SOSB幅值、频率、持续时间分别为(41±27)、(150±71)、(301±109)μV,(5.8 ±1.6)、(6.9 ±1.4)、(7.8 ±1.2)次/min,(2.7±0.6)、(3.4±0.7)、(4.2±0.7)s,各组比较,差异有统计学意义(F=50.751,4.293,13.159,P<0.05).结论 SO肌电检测可以从电生理的层面反映SO的功能,有望成为临床研究、检测SO功能的新方法.

Abstract：

Objective To observe the characteristics of electromyography of sphincter of Oddi (SO) in patients with cholelithiasis after common bile duct exploration,and investigate new methods for detecting the motility of SO.Methods The basal pressure of SO(SOBP)and electromyography of SO were detected in 33 patients with cholelithiasis who were reexamined at the Southwest Hospital from January to October,2010.All patients were divided into low SOBP group,normal SOBP group and high SOBP group.The amplitude,frequency and duration of SO spike burst(SOSB)of the three groups were compared.Results The numbers of patients in the low SOBP group,normal SOBP group and high SOBP group were 14,13 and 6,respectively.The mean SOBP of the low SOBP group,normal SOBP group and high SOBP group were(3.1±1.2),(18.5±7.6),(39.8±4.8)mm Hg (1 mm Hg=0.133 kPa).The amplitude,frequency and duration of SOSB were(41±27)μV,(5.8±1.6) times/minutes and(2.7±0.6)s in the low SOBP group,and(150±71)μV,(6.9±1.4)times/minutes and (3.4±0.7)s in the normal SOBP group,and(301±109)μV,(7.8±1.2)times/minutes and(4.2±0.7)s in the high SOBP group,respectively,with significant difference among the three groups(F=50.751,4.293,13.159,P<0.05).Conclusion The results of electromyography of SO could reflect the function of SO,and it is possible to be a prospective method in the clinical research of SO.     

生长抑素类似物对Oddi括约肌肌电活动的双向调节作用及其临床意义

目的 探讨生长激素类似物善得定(sandostatin SS)对Oddi括约肌(Sphincter of oddi,SO)肌电活动的双向调节作用及其临床意义.方法 40只空腹18h成年健康家兔随机分为5组,即静脉注射生理盐水组;皮下注射生理盐水组;小剂量静脉滴注SS组;大剂量皮下注射SS组;静脉注射654-2后小剂量静脉滴注SS组.两对钩状双极金属电极分别置于乳头及十二指肠浆膜下,使用RM6240多道生理仪及信号采集处理系统,实验在PBG-1型生理实验屏蔽柜内进行.连续记录SO肌电活动120～150min.结果 对照第一、第二组用药前后SO肌电活动无明显变化,仍表现为单发、规律的SO锋电位(spike potentials of SO,SPSO);小剂量静脉滴注SS组给药后2～3min出现规律、间断的SO肌电簇(myoelectronic activity of SO,MASO);大剂量皮下注射SS组给药后2～3min,SO肌电活动消失,进入抑制状态;静脉注射654-2后小剂量静脉滴注SS,SPSO和MASO均不复出现.结论 高浓度的SS可以抑制SO肌电活动,导致SO处于舒张状态;而低浓度维持剂量的SS可以使SO肌电活动处于兴奋状态,导致SO蠕动加快;阻断乙酰胆碱能神经可以消除SS对SO肌电活动的兴奋作用.     

同步检测胆囊及Oddi氏括约肌电活动和胆管压力的兔模型

目的 建立同步检测胆囊及Oddi括约肌肌电活动及胆囊、胆总管压力的动物模型.方法 对6只家兔用7F静脉深穿管分别经肝穿刺进入胆囊腔及经十二指肠腔插入胆总管.将铂金电极缝在胆囊底部浆膜上.以多通道生理仪记录家兔的胆囊及Oddi括约肌肌电信号和胆囊、胆总管压力.结果 Oddi氏括约肌肌电的峰电位＞0.05 mV,最大电位为0.26 mV,频率为0～2次/分;而慢波电位≤0.05 mV,频率为8⒍11次/分.胆囊内压力最大为15 cm H2O(6.83～15.00 cm H2O),胆总管最大压力为22 cm H2O(11～22 cm H2O).胆囊肌电活动的波形缺乏规律性.结论 兔可以作为同步检测胆囊及Oddi氏括约肌肌电活动和胆囊、胆总管压力的模型.     

犬双侧迷走神经干切断术对Oddi括约肌肌电的影响

目的研究双侧迷走神经干切断术对Oddi括约肌(SO)肌电的影响。方法禁食16~18h(可自由饮水),成年杂种犬麻醉后,实验组行膈肌水平双侧迷走神经干切断术加幽门成形术,对照组仅行幽门成形术。手术后8周行SO肌电记录(SOE)。结果实验组慢波幅度明显升高,快波未观察到显著性变化。结论双侧迷走神经干切断术对SO肌电产生明显影响。     

犬Oddi括约肌狭窄模型的建立及其胆道动力学的变化

目的建立犬Oddi括约肌（sphincter of Oddi,SO）狭窄模型,探讨其胆道动力学的变化。方法禁食16～18h成年杂种犬麻醉后,超声测量胆总管管径。实验组行经腹切开十二指肠,机械性损伤SO致其狭窄;对照组仅行经腹切开十二指肠,术毕饲养。定期检查肝功能,4周后再次麻醉下行超声测量胆总管管径及开腹行SO测压。最后切取SO及周围组织行病理检查。结果实验组术后4周肝功能TBIL、DBIL、GGT、ALP明显高于术前,超声测量胆总管管径大于术前,病理检查发现括约肌组织纤维化,而对照组均无明显变化。与对照组相比,实验组胆总管及SO基础压明显升高,SO收缩幅度降低,收缩频率升高,收缩时间缩短。结论SO狭窄模型成功建立;Oddi括约肌狭窄后其胆道动力学发生明显改变。     

Oddi括约肌功能障碍分型研究的临床意义

Oddi括约肌功能障碍是一种功能性胃肠疾病,由于缺乏典型的症状和体征,诊断较为困难.Oddi括约肌功能障碍分型标准的提出,显著提高了该疾病的诊断水平,对合理选择治疗措施具有重要的临床意义.文章概述了近年来Oddi括约肌功能障碍分型研究及相关诊断、治疗进展.     

Oddi括约肌异常与胆胰疾病

Oddi括约肌异常可以分为解剖形态异常和功能失调,解剖形态异常主要包括狭窄和关闭不全;功能失调主要包括功能亢进和功能低下.许多胆胰疾病的发生均与Oddi括约肌结构和功能的异常有关,主要相关的胆胰疾病有:先天性胰胆管合流异常、胆囊结石、原发性胆管结石、胆囊切除术后综合征和胰腺炎.正确认识Oddi括约肌异常对于提高相关胆胰疾病的诊断和治疗水平具有重要意义.     

Sleeve sphincter of Oddi (SO) manometry: a new method for characterizing the motility of the sphincter of Oddi

BACKGROUND/PURPOSE: Perfused multilumen sphincter of Oddi (SO) manometry is accepted as the gold standard for diagnosis of SO dysfunction. However, this technique is associated with a relatively high incidence of post-procedure acute pancreatitis. In addition, triple-lumen manometry recordings may be difficult to interpret, as movement may produce artifacts. We have refined the development of a sleeve sensor for human SO manometry. This assembly aims to overcome the above limitations. In this study the accuracy of sleeve SO manometry (SOM) has been evaluated and compared with standard triple-lumen perfused SOM. METHODS: Patients undergoing SO manometric studies consented to having both standard triple-lumen and sleeve SOM. A total of 32 paired studies were performed in 29 patients. Diagnosis was made only from standard triple-lumen SOM and the patient treated accordingly. For each study, SO basal pressure, contraction, amplitude, and frequency were recorded. RESULTS: There was no statistically significant difference in the recordings of SO basal pressure, contraction, amplitude, and frequency between the two techniques. A strong correlation was demonstrated between SO basal pressure determined with the two catheters. The accuracy of sleeve SOM is comparable to standard triple-lumen SOM, with less movement artifact. One patient developed mild post-manometric pancreatitis. CONCLUSIONS: The sleeve catheter records SO pressures with comparable values to standard triple-lumen SOM. The sleeve assembly potentially can replace the use of the perfused triple-lumen catheter for the objective diagnosis of SO dysfunction.     

Oddi括约肌及其功能障碍研究进展

人类对Oddi括约肌的认识已逾百年.它精确调控着胆汁和胰液的周期性排放及定向流动.但时至今日我们对其研究仍有不足,如何准确评价其功能及对其功能障碍进行有效的诊治仍是一个难题.近年来,随着对该括约肌解剖、调控的进一步研究及检测方法的进步,人们对它的认识也不断加深,对其功能障碍的发生机制、诊断及治疗方法也有了许多新的进展.本文就上述几个方面作一总结.     

胆囊切除术对家兔Oddi括约肌运动功能的影响

目的探讨胆囊切除术对家兔Oddi括约肌运动功能变化的影响。方法将16只成年家兔随机分成正常对照组、胆囊切除术组,每组8只。手术4周后进行Oddi括约肌压力及肌电的同时测定。结果压力测定:胆囊切除术组胆总管压力降低,Oddi括约肌基础压、收缩波幅升高(P<0.01);肌电测定:肌电活动由原来的锋电位变为肌电簇,波幅升高,持续时间延长(P<0.01),收缩频率未见明显变化。结论胆囊切除术后家兔Oddi括约肌功能有明显改变;Oddi括约肌蠕动增强以加快胆汁的排泄。     

Advances in research and clinical practice in motor disorders of the sphincter of Oddi

Perfusion manometry of the sphincter of Oddi (SO) using a pneumohydraulic capillary infusion system records phasic wave activity superimposed on basal pressure. A triple-lumen catheter allows the recording of propagation of the phasic waves. Microtransducer manometry is an alternative that permits prolonged recording of biliary pressure without the need for infusion. A cyclic change is recognized in SO motility in coordination with the migrating motor complex (MMC) of the duodenum during fasting. SO contractions occur at maximal frequency and amplitude during phase 3 of the duodenal MMC. Using two microtransducer catheters placed by duodenoscopy, a cyclic elevation of biliary pressure can be recorded in concert with phase 3. These findings indicate that human SO contractions impede bile flow. SO dysfunction causing biliary-type pain can be diagnosed by manometry. The pressure elevation during phase 3 may contribute to the development of pain in patients with biliary dyskinesia. Gastrectomy and proximal duodenal transection were proven to affect sphincter motility, as evidenced by the paradoxical response to cholecystokinin. Choledocholithiasis and hepatolithiasis are associated with low basal pressure, presumably due to repeated injury to the sphincter by passing stones. SO and biliary manometry leads to better understanding of biliary dynamics and the pathophysiology of biliary diseases. Received: March 25, 2002 / Accepted: April 14, 2002 Offprint requests to: M. Tanaka