Hepatolithiasis Classification Based on Anatomical Hepatectomy.

BACKGROUND: This study aims to propose a novel classification system to standardize the treatment of hepatolithiasis. METHODS: A hepatolithiasis classification named LHO was proposed to represent the distribution of stones in the segmental bile ducts and the hepatic atrophy associated with the stones (L), the existence of stones or strictures in the hilar bile duct (H), and dysfunction of the Oddi sphincter (O), which can be used to formulate ideal surgical protocols. One hundred and forty-seven primary hepatolithiasis patients treated between 2013 and 2018 were classified into different types and divided into two groups. If the patient's actual surgical procedure matched the ideal surgical protocol, the patients were included in the matching group; otherwise, patients were included in the nonmatching group. The rates of residual stones, recurrence, and a good quality of life (QOL) were analyzed among the patients in the matching and nonmatching groups and previous reports. RESULTS: According to the classification of each patient, 77.6% of the patients were included in the matching group, and 22.4% were included in the nonmatching group. The rates of residual stones, recurrence, and a good QOL were significantly better in the matching group than in the nonmatching group (9.6% vs. 27.3%; 8.0% vs. 35.0%; 89.5% vs. 65.4%); the rates of residual stones and a good QOL were also better than those in previous reports (9.6% vs. 19.1%; 89.5% vs. 61.6%). CONCLUSIONS: The LHO classification can comprehensively reflect the key points of treatment, which is beneficial for formulating effective and standardized surgical plans of hepatolithiasis.

Long-term outcomes of surgical approaches for bilateral hepatolithiasis: A real-world six-decade experience at a single center.

BACKGROUND: Bilateral hepatolithiasis is an intractable disease and repeated attacks of acute cholangitis seriously threaten patient health. The surgical approaches evolve along with gradually greater understanding of its pathophysiology. METHODS: This is a retrospective cohort study for bilateral hepatolithiasis from January 1958 to December 2018. Before May 1993 (Group A, n = 70), three surgical approaches were adopted: 37 patients with common bile duct exploration (CBDE), 29 with choledochoenterostomy (CE) and four with partial hepatectomy (PH). After June 1993 (Group B, n = 150), 101 patients underwent Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS), and 16 with CBDE, 21 with CE, 12 with PH. The perioperative and long-term outcomes were compared. RESULTS: After 1993, the cholangitis recurrence rate significantly decreased from 49.2% to 20.9%, and the stone recurrence rate from 76.3% to 37.1% (both P < .001). Also, the stone-/cholangitis-free durations were prolonged significantly (median: 50.8 vs 26.4/49.6 vs 16.2 months, both P < .001). Preoperative cholangitis was an independent risk factor for stone recurrence (hazard ratio [HR] = 1.863, P = .018), and residual stone for cholangitis recurrence (HR = 2.838, P < .001). OSPCHS and PH were protective surgical approaches for recurrent stone (CBDE: reference; OSPCHS: HR = .469, P = .016, PH: HR = .219, P = .018) and cholangitis (CBDE: reference; OSPCHS: HR = .421, P = .010, PH: HR = .283, P = .093). CONCLUSIONS: For bilateral hepatolithiasis, the management should focus on hepatobiliary lesion eradication and Oddi sphincter function preservation.

Surgical strategy for recurrent common bile duct stones: a 10-year experience of a single center.

Recurrence of common bile duct stones (CBDS) is common after surgical stone extraction, but the causes of recurrence are not fully understood. This study aimed to report the experience of treating recurrent CBDS. A total of 106 consecutive cases of recurrent CBDS treated from January 2006 to December 2015 were included. During surgery, the choledochoscopic pass-through test was performed to assess the structure and function of the duodenal papilla. The choledochoscopic pass-through test revealed 62 patients (58.49%) with incomplete closure of the lower end of the common bile duct, and 28 (26.42%) with stenosis at the lower common bile duct. Intra-operative bile bacterial culture was positive in 98 (92.45%) patients. The rate of complete stone clearance was 99.1%. The total recurrence rate of CBDS was 3.13%. The long-term success rate of surgical treatment (excellent and good) reached 92.7% .Duodenal papilla (Oddi sphincter) dysfunction is the main cause of recurrent CBDS. Common bile duct exploration with stone extraction, hilar ductoplasty, and Roux-en-Y hepaticojejunostomy can effectively eliminate the recurrence of CBDS and reduce the incidence of post-hepaticojejunostomy complications. Thus, it is an optimal surgical procedure for recurrent CBDS.

Regulation of microrna expression level by choleretic therapy in functional disorders of the gallbladder and оddi's sphincter in children.

OBJECTIVE: The alm: To study the effect of choleretic therapy on the level of microRNA expression in functional disorders of the gallbladder and Oddi's sphincter in children. PATIENTS AND METHODS: Materials and methods: Fifty patients with functional disorders of the gallbladder and Oddi's sphincter who received standard therapy in combination with ursodeoxycholic acid, 20 patients - standard therapy without ursodeoxycholic acid, and 20 healthy children were examined. The level of expression of microRNA-378f, microRNA-4311, microRNA-4714- 3p in the blood serum by the method of real-time polymerase chain reaction with reverse transcription according to the protocol TaqMan Gene Expression Assays was performed. RESULTS: Results: It was demonstrated that the activity profile of microRNA-4714-3p was significantly lower in those examined with functional disorders of the gallbladder and Oddi's sphincter than in practically healthy children (p<0.05). After standard therapy combined with ursodeoxycholic acid in children with functional disorders of the gallbladder and Oddi's sphincter, the level of expression of microRNA-378f is significantly higher than before therapy (5.23±0.70 SU and 2.02±0.57 SU respectively) (p<0.05). Against the background of standard therapy with the addition of ursodeoxycholic acid or without it, the expression profile of microRNA-4714-3p in the blood serum in children with functional disorders of the gallbladder and Oddi's sphincter significantly decreased (1.93±0.58 SU and 1,14±0,53 SU respectively) (p<0.05). CONCLUSION: Conclusions: Ursodeoxycholic acid in children with functional disorders of the gallbladder and Oddi's sphincter affects the activity of generation of gene regulators of the cellular mechanisms of microRNA-378f and microRNA-4714-3p.

Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación de caso / Gall bladder agenesis associated with recurrent acute pancreatitis. Case presentation

Introducción: La Agenesia de la Vesícula Biliar es una anomalía congénita rara, entre 13 y 65 por ciento por cada 100 000 habitantes. Su asociación con pancreatitis aguda es extremadamente rara. Objetivo: Presentar un caso de Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente.Presentación del caso: Se presenta una mujer de 85 años, con antecedentes de litiasis vesicular por ultrasonido (US), y crisis de dolor abdominal, vómitos e hipotensión frecuentes, a quien remitían con tratamiento médico. Acudió al hospital con dolor abdominal, vómitos e hipotensión. Al examen físico se constató: dolor epigástrico, sin reacción peritoneal ni tumor palpable. El US informó vesícula no visible. En menos de 24 horas evolucionó con shock, disfunción múltiple de órganos y muerte. En la necropsia se encontró Agenesia de la Vesícula Biliar (AVB) y pancreatitis aguda necrotizante. Conclusiones: La AVB es una anomalía congénita rara, de difícil diagnóstico preoperatorio, por lo que casi siempre es un hallazgo de la cirugía abdominal o en la autopsia. Su asociación con pancreatitis aguda es rara. La pancreatitis puede ser debida a Disfunción del Esfínter de Oddi o de origen idiopático(AU)

Introduction: Gallbladder agenesis (GA) is a rare congenital anomaly, with a reported incidence ranging between 13-65 percent per a 100 000 population. Its association with acute pancreatitis is extremely rare. Objective: To present a case of GA associated with recurrent acute pancreatitis. Case Presentation: We present an 85 years old woman whose clinical record reported a bladder stonediagnosis by US, that arrive to the hospital with frequent episodes of intermittent vomiting, abdominal pain and hypotension. She was admitted at hospital with upper abdominal pain, vomiting and hypotension. At the physical examination the abdomen was soft, with mild epigastric tenderness, without tenderness rebound or tumor. US report gallbladder not visible. In less than 24 hours the patient evolved with shock, multiple organ failure and death. Gallbladder agenesis and acute pancreatitis were found in autopsy. Conclusions: The GA is a rare congenital anomaly, difficult to establish a correct preoperative diagnosis, always found during the abdominal surgery or autopsy. Its association with acute pancreatitis is very uncommon. Pancreatitis may be due to of Oddi Sphincter's Dysfunction (SOD) or idiopathic origin(AU)

Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación de caso / Gall bladder agenesis associated with recurrent acute pancreatitis. Case presentation

Introducción: La Agenesia de la Vesícula Biliar es una anomalía congénita rara, entre 13 y 65 por ciento por cada 100 000 habitantes. Su asociación con pancreatitis aguda es extremadamente rara. Objetivo: Presentar un caso de Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación del caso: Se presenta una mujer de 85 años, con antecedentes de litiasis vesicular por ultrasonido (US), y crisis de dolor abdominal, vómitos e hipotensión frecuentes, a quien remitían con tratamiento médico. Acudió al hospital con dolor abdominal, vómitos e hipotensión. Al examen físico se constató: dolor epigástrico, sin reacción peritoneal ni tumor palpable. El US informó vesícula no visible. En menos de 24 horas evolucionó con shock, disfunción múltiple de órganos y muerte. En la necropsia se encontró Agenesia de la Vesícula Biliar (AVB) y pancreatitis aguda necrotizante. Conclusiones: La AVB es una anomalía congénita rara, de difícil diagnóstico preoperatorio, por lo que casi siempre es un hallazgo de la cirugía abdominal o en la autopsia. Su asociación con pancreatitis aguda es rara. La pancreatitis puede ser debida a Disfunción del Esfínter de Oddi o de origen idiopático(AU)

Introduction: Gallbladder agenesis (GA) is a rare congenital anomaly, with a reported incidence ranging between 13-65 percent a 100 000 population. Its association with acute pancreatitis is extremely rare. Objective: To present a case of GA associated with recurrent acute pancreatitis. Case Presentation: We present an 85 years old woman whose clinical record reported a bladder stonediagnosis by US, that arrive to the hospital with frequent episodes of intermittent vomiting, abdominal pain and hypotension. She was admitted at hospital with upper abdominal pain, vomiting and hypotension. At the physical examination the abdomen was soft, with mild epigastric tenderness, without tenderness rebound or tumor. US report gallbladder not visible. In less than 24 hours the patient evolved with shock, multiple organ failure and death. Gallbladder agenesis and acute pancreatitis were found in autopsy. Conclusions: The GA is a rare congenital anomaly, difficult to establish a correct preoperative diagnosis, always found during the abdominal surgery or autopsy. Its association with acute pancreatitis is very uncommon. Pancreatitis may be due to of Oddi Sphincter's Dysfunction (SOD) or idiopathic origin(AU)

Comparative Relaxant Effects of Ataciguat and Zaprinast on Sheep Sphincter of Oddi.

BACKGROUND: Relaxing the sphincter of Oddi (SO) is an important process during endoscopic retrograde cholangiopancreatography (ERCP) procedures. This issue suggests that the easier the sphincterotomy and cannulation, the more post-ERCP complications decrease. AIMS: To compare the relaxant effects of ataciguat (a novel soluble guanylyl cyclase activator) and zaprinast (an inhibitor of phosphodiesterase 5) on sheep SO in vitro, thus testing whether they can be used during ERCP. STUDY DESIGN: Animal experimentation. METHODS: Sheep SO rings were placed in tissue baths and their isometric tension to ataciguat and zaprinast were tested. We also tested their isometric tension against ataciguat in the presence of 1H-(1,2,4) oxadiazole (4,3-a) quinoxalin-1-one (ODQ) which is a soluble guanylyl cyclase inhibitor. RESULTS: Ataciguat and zaprinast both triggered concentration addicted relaxation on sheep SO rings (p=0.0018, p=0.0025 respectively) but the relaxation of the ataciguat was significantly greater than that of zaprinast at all concentrations (p=0.0024). It was observed that decreased relaxation responses were initiated by ataciguat in the presence of ODQ (p=0.0012). CONCLUSION: Ataciguat and zaprinast both have relaxing effects on sphincter of Oddi, although that of zaprinast is lower. We believe that ataciguat and zaprinast can be used in ERCP procedures in order to relax the sphincter of Oddi and thus can be used locally in order to decrease complications.

Controversy on the Oddi Sphincter Function in the Treatment of Hepatolithiasis：Preservation Versus Deprivation / 中国微创外科杂志

[Summary] The controversy remains on whether the Oddi sphincter function should be preserved or deprived in the treatment of hepatolithiasis .The surgical approaches achieving both hepatobiliary lesions clearance and Oddi sphincter preservation have been widely accepted .The biliary-enterostomy is suspected to increase the risk of reflux cholangitis and cholangiocarcinoma due to iatrogenic Oddi sphincter deprivation.Endoscopic sphincterotomy (EST) as a minimally invasive method still needs further research to determine its role in hepatolithiasis management .

Biliary tract and pancreatic surgery complicated by acute pancreatitis: a clinical analysis.

OBJECTIVE: To study the clinical treatment features of biliary tract and pancreatic surgery complicated by acute pancreatitis. METHODS: A retrospective analysis of 21 cases of biliary tract and pancreatic surgery complicated by acute pancreatitis in the Department of General Surgery in our hospital during May 2005 to July 2011 was performed; the clinical treatment features were analyzed in terms of surgical option, onset interval of acute pancreatitis after last surgery, length of stay in hospital and Ranson score. RESULTS: There was no statistic difference between the two groups (A: The onset interval of acute pancreatitis after last surgery < 0.5 year. B: The onset interval of acute pancreatitis after last surgery > 0.5 year) in pathogenetic condition and length of stay in hospital. All patients were discharged after treatment, a follow-up of 6-18 months found no recurrence of pancreatitis. CONCLUSION: There is no relevance between the treatment feature and onset interval of biliary and pancreatic surgery complicated by acute pancreatitis. The disease is still treated meanly with symptomatic and supportive treatment, while the etiological treatment is also particularly important.

Effect of Acupuncture on Motor Function of Extrahepatic Biliary System of Guinea Pig / 世界科学技术-中医药现代化

This study was aimed to compare the effects of acupuncture stimulation on different acupoints, which included LR14-Qimen, ST25-Tianshu, GB34-Yanglingquanand CO11-pancreas and gallbladder (auricular vagus nerve intensively distributed areas) on gallbladder pressure and Oddi sphincter function of guinea pig, in order to discuss acupuncture effect on different acupoints in the regulation of motor function of extrahepatic biliary system. A total of 20 adult guinea pigs of both sexes were randomly divided into two groups, with 10 in each group. The detection was made on changes of Oddi sphincter electromyography and gallbladder pressure before and after acupuncture. A double-hook electrode was implanted into the Oddi sphincter for the detection of Oddi sphincter electromyography. And one small artificial balloon was put into the gallbladder to measure the intrabiliary pressure. After the guinea pig was anesthetized, changes of gallbladder pressure as well as the electromyography frequency and amplitude index of Oddi sphincter of the normal guinea pig were recorded. When the guinea pig was stabilized, acupuncture was given on LR14, ST25, GB34 and CO11 for 1 min. Observations were made on acupuncture effects of gallbladder pressure and Oddi sphincter function of guinea pig. The results showed that after acupuncture on LR14 and ST25, the electromyography frequency of Oddi sphincter was obviously increased compared with before acupuncture (frequency:P < 0.01, amplitude:P < 0.05); the gallbladder pressure was obviously decreased (P < 0.05). After acupuncture on CO11 and GB34, the electromyography frequency and amplitude index of Oddi sphincter were obviously decreased compared with before acupuncture (P < 0.05); the gallbladder pressure was obviously increased (P < 0.01). It was concluded that acupuncture on LR14 and ST25 can obviously inhibit the movement of gallbladder and promote the myoelectricity release of Oddi sphincter. Acupuncturing on CO11 and GB34 can apparently promote the shrinking movement of gallbladder and inhibit the myoelectricity release of Oddi sphincter.

Effect of combined laparoscopic treatment of gallstone duodenoscope on common bile duct stones / 国际外科学杂志

Objective To study the effect of laparoscopic cholecystectomy endoscopic sphincterotomy combined with Oddi lithotomy (EST) treatment of gallbladder stone on common bile duct stones. Methods A retrospective analysis between May 2003 and June 2009 ,the combined treatment of LC and EST in 78 patients with common bile duct stones was retrospectivelly analyzed. First, bile duct stones were removed by EST, then laparoscopic cholecystectomy was performed within 5 days. Results EST was performed successfully in 76 cases (97%), failure in 2 cases, 1 case abdominal choledochojejunostomy due to the end of bile duct stenosis; one cases of common bile duct stone diameter of 1.6 cm, firm, failure of mechanical lithotripsy received common bile duct ploration T-tube drainage 76 cases of laparoscopic operation is successful, without obvious bleeding, bile leakage and other severe complications. Conclusions The advantages of EST + LC for the gallbladder stones and common bile duct stones with less trauma, faster recovery, fewer complications, and no T-tube drainage, etc; this is a safe and effective treatment.

Clinical analysis of short- and long-term complications after endoscopic Oddi's sphincterotomy in 95 patients / 中华肝胆外科杂志

Objective To investigate the short- and long-term complications after endoscopic Oddi's sphincterotomy (EST) upon endoscopic retrograde cholangiopancreatography (ERCP) procedure and determine whether the size of EST correlates to the occurrence of EST complications.Methods 95 cases receiving EST in the process of ERCP in our hospital were studied and followed up. The patients were divided into large, moderate and small incision groups according to the size of EST and the states of short-term and long-term EST complications were statistically analyzed.Results The incidence of short-term complications of EST was 18. 94% (18/95). They included bleeding in the process of ERCP in 11 cases, delayed bleeding in 3, acute pancreatitis in 1, acute cholangitis in 2 and duodenal perforation in 1. All these patients but 1 with duodenal perforation were discharged after undergoing symptomatic treatments. Eleven out of the 95 patients had long-term complications (11.57 % ). These included biliary system infection in 5 cases, recurrent calculus of bile duct in 3, papilla stricture in 1 and chronic relapsing pancreatitis in 2. All 11 patients recovered after therapeutic ERCP again or symptomatic drug treatments. There was no significant difference in incidence of short-term (χ2 =2.433, P=0.296) or long-term complications (χ2 = 1.151, P=0.562) among the 3 groups. Furthermore, there was no statistical correlation between the incision size of Oddi and complications including operative bleeding (P=0.109), short-term complications (P=0.124) and longterm complications(P=0.402). Conclusion There are many short-term and long-term complications after EST, but there is no correlation between the complications and the incision size of Oddi. The occurring rate of complications might be reduced through accurate direction of papilla incision, avoidance from injury of blood vessel, keeping bile drainage unobstructed and protection of the function of Oddi sphincter as far as possible in the process of ERCP.

Changes and significance of the contents of cholecystokinin acceptors and nitric oxide synthuse in Sphincter of Oddi and the contents of cholecystokinin and nitric oxide in the blood of patients with calculus of bile duct / 中国综合临床

Objective To investigate the changes and significance of the contents of cholecystokinin (CCK) acceptors and nitric oxide synthase (NOS) in sphincter of Oddi and the contents of CCK and nitric oxide (NO) in the blood of the patients with calculus of bile duct. Methods The contents of CCK acceptors and NOS in sphincter of Oddi and the contents of CCK and NO in the blood were determined in 41 patients with gallstone and 6 controls. Results The contents of CCK and NO in the blood of patients with gallstone were significantly higher than that in control [ ( 38.91±4.85 ) pmol/L vs ( 30.67±1.81 ) pmol/L; (40.84±4.74 ) pmol/L vs ( 32.81±1.11) pmol/L] ;The contents of CCK acceptors and NOS in sphincter of Oddi in the patients with gallstone were signifi-cantly lower than in the controls [ (67.59±5.87 ) ng/L vs ( 78.99±1.71 ) ng/L; ( 457.52±45.40 ) ng/L vs ( 519.61±11.38 ) ng/L] ;The contents of CCK and NO in the blood in the different groups with calculus of bile duct were significantly different from those in the controls. Conieusion The degree of the decrease of the contents CCK acceptors and NOS in sphincter of Oddi leads to the decrease of Oddi sphincter function,resuting in cholestasis and promoting the formation of bile duct stone.

Correlation between NO, CCK, VIP and Oddi sphincter on the CRUSe of bile duct calculus / 国际外科学杂志

Bile duct stone is the common and frequently-occurring disease, its incidence upwards trend. In recent years, people realize that Oddi sphincter movement disorders play an important role in the inci-dence of bile duct stones. NO, CCK, VIP and theie interactian have effects on sphincter function and dis-charged from the regulation of bile. These factors are necessary to conduct an in-depth study to investigate the cause of bile duct stone and its treatment.

Clinical significance of duodenoscopy combined with choledochoscopy in the test of the functions of Oddi's sphincter / 中国微创外科杂志

Objective To determine operation procedure according to Oddi's sphincter functions decteted by preoperative duodenoscopy combined with intraoperative choledochoscopy (IOC). Methods The duodenal papillae and Oddi's sphincter functions of 319 cases with hepatobiliary calculus were detected by preoperative duodenoscopy, ERCP and IOC. Results As for the functions of Oddi's sphincter, 79 cases were superior, 152 cases favorable and 88 cases poor. Conclusions For patients with hepatobiliary calculus whether Oddi's sphincter is reserved according to the Oddi's sphincter function.

Endoscopic sphincterotomy for the dysfunction of Oddi sphincter in postcholecystectomy syndrome / 中华消化内镜杂志

Objective To approach the treatment value of endoscopic sphincterotomy for the dysfunction of Oddi sphincter in postcholecystectomy syndrome.Methods Endoscopic sphincterotomy was undergone in 28 cases with ultimate diagnosis of Oddi sphincter dysfunction after BUS, ERCP , basal sphincter pressure examination and ruled out the patients with retained or recurrent stones,stricture or carcinoma in the bile duct having postcholecystectomy syndrome.Results Symptoms disappeared completely after the treatment in 18 cases,alleviated apparently in 5 cases and other 2 cases after the second treatment,without alleviation in 3 cases,the effective rate is 89.3%(25/28).No severe complication happened.Conclusion It is assumed that endoscopic sphincterotomy is a micro-traumatic,safe and effective treatment for the dysfuction of Oddi sphincter in postcholecystectomy syndrome.

Study on the primary closure of bile duct incision of laparoscopic bile duct exploration and balloon dilatation catheter dilatation / 中华消化内镜杂志

Objective To discuss the indications and complications of primary closure of bile duct incision in laparoscopic bile duct exploration and balloon dilatation catheter dilatation to treat the papillary stenosis and the intrahepatic bile duct stenosis. Methods A pospective study of 42 ptients of bile duct incision closure primary in laparoscopic bile duct exploration and balloon dilatation catheter dilatation, laparoscopic bile duct exploration and extraction of bile duct stones with choledochotomy was first adopted in order to clear the stones, then followed by the balloon dilatation catheter(explosive pressure reached 2020 kPa, used 505kPa) to dilate the papillary stenosis and the intrahepatic bile duct stenosis (CT-7542～ CT-75104) until the stenosis was released. Whether the primary closure of duct incision was selected or not, it was based on the situation of intraoperative choledochoscopic exploration, if it had been selected, the closure of bile duct incision would accepted by using absorbable suture 4-0 or 5-0, without placing bile duct drainage.It was routinely to place the drainage tube in the oriffice of the lesser omentum. Results 41 out of 42 patients had obtained successful duct clearance, the dilatation of the stenosis to reach the expected expansion and without bile leakage. One patient had bile leakage about 30-150 ml daily persisted for 4 days through cured conservatively. Conclusion Eventually it was safe and effective for some patients who had completed successful duct clearance and the dilatation of the stenosis to reach the expected expansion with the balloon dilatation catheter. They were adopted to the primary closure of duct incision using absorbable suture and did not need to place bile duct drainage.

Effects of protease inhibitor gabexate mesilate on motility of human Oddi's sphincter / 中华消化杂志

0.05).②Gabexate mesilate significantly reduced the frequency of contraction (P0.05).③High dose gabexate mesilate could markedly reduce the motility index ( P

Effects of cholecystokinin on canine Oddi sphincter function after pancreas transplantation with bladder drainage / 中国普通外科杂志

Objective To study the effects of cholecystokinin (CCK) on canine Oddi sphincter(SO)function after pancreas transplantation with bladder drainage. Methods Normal canine and transplant canine SO manometry before and after CCK administration was carried out. Results SO basal pressure in control group was(18 5?2 8) mm Hg, frequency was(9 7?1 5)per min, amplitude was (47?6) mm Hg, motility index was(236?56). After CCK administration, basal pressure, frequency, amplitude and motility index decreased significantly to(10 2?2 2) mm Hg ,(5 0?1 2)per minute,(19?5) mm Hg and(50?17), all P

Oddi sphincter lesions:a clinical and histological study / 中国普通外科杂志

Objective To explore the relationship between the histological alterations of Oddi sphincter lesions and clinical manifestations. MethodsFrom October 1995 to May 2003, biopsies of Oddi sphincter were undertaken during transduodenal sphincteroplasty (TSP) in 32 cases. Specimens were stained with Van Gieson Mason staining. ResultsThirty one out of 32 specimens were found with histological alterations in Oddi sphincter including diffuse fibrosis in 87 1% (27/31) , adenomyosis in 2 cases and chronic inflammatory infiltration in 2 cases. Impacted stone in the terminal common bile duct, benign papillary stenosis and visible postpancreatitis parenchymal changes were all found accompanying severe fibrosis of Oddi sphincter. ConclusionIn patients with impacted stones in the ampulla, intracholedochal sludge with recurrent cholangitis, and relapsing pancreatitis, endoscopic sphincterotomy is recommended.