Clinical Study On The Effect Of EST On Function Of Sphincter Of Oddi

[Objective]:Comparative analysis of the influence about Endoscopic shphincterotomy(EST) incision length, whether nasal biliary drainage on Sphincter of Oddi’s (SO) function.[Method]:The clinical data collected in the Second Affiliated Hospital of Kunming Medical University of hepatobiliary department from January 2012 to December2013 D which diagnosed extrahepatic bile duct stones underwent EST treatment in 114 cases and group. Among of 73 cases with nasal biliary drainage in (A group),41 patients without nasal biliary drainage (B group),46 cases with EST which incision length>0.8cm (C group),68 cases with EST which incision length<0.8cm (group D). Retrospectly analysis the SO incision length, nasal biliary drainage effect on the function of SO.1. All patients were given the liver function, blood analysis, blood amylase on postoperative 3,7days, and comparative analysis between A and B group. 2) All the patients given clinical follow-up and given dilute barium meal examination after one week, half a year, one year, and compared with the C and D group.3) According to the diagnostic criteria of postoperative complications of EST to evaluate whether patients with complications or not, and compared with the C and D group. Data processing:The experimental data were analyzed by SPSS 17.0 statistical software, which conform to normal distribution measurement data by the mean and standard deviation (X± S) said, compared with the X2test, there were significant differences in P<0.05.[Result]:1.The liver function, blood amylase point out the Alanine aminotransferase (ALT), Direct bilirubin(DBIL), amylase AMS were more higher in B group than A group after EST operation 3 days, The comparative analysis were statistical difference (P<0.05), Aspartate aminotransferase(AST), Alkaline phosphatase(AKP) had no obvious difference, comparative analysis was not statistically significant (P>0.05). There were 5 patients whose white blood cell increased. The white blood cells were normal after 7 days,ALT, DBIL, AMS, AST, AKP had no obvious difference, comparative analysis was not statistically significant (P>0.05).2.The 7 day after EST, 22 cases with Bile duct pneumatosis,13 cases in C group,9 cases in D group, barium reflux in 15 cases,10 cases in C group,5 cases in D group. The first half of year the Bile duct pneumatosis in 12 cases,8 cases in C group,4 cases in D group, barium reflux in 10 cases,7 cases in C group,3 cases in D group. After one year with Bile duct pneumatosis in 4 cases,4 cases in C group,0 cases in D group, barium reflux in 3 cases,3 cases in C group,0 cases in D group. The greater of the EST incision the more serious injury, the risk of Bile duct pneumatosis and barium reflux were more.The length of the incision and gas and barium reflux incidence comparison were statistically significant.3.8 cases with complications,6 cases in C group,2 cases in D group. EST incision is greater the risk of complications is higher. The length of incision and complications were statistically significant.[Conclusion]:1.it suggesting that EST have direct injury to SO in a short term after operation, and the Endoscopic nasobiliary drainage after EST is effectively for the exclusion of bile and pancreatic juice.2. The greater of the EST incision can lead ed to the more serious injury, meanwhile the risk of Bile duct pneumatosis and barium reflux were more.3. The EST postoperative complications is related to incision length, the incision length of EST is greater, the more risk of complications.