The Clinical Significance Of Sphincter Oddi`S Insufficiency After Cholecystectomy

Abstract

Purpose of research. To evaluate the clinical significance of the loss of the closure function of the Oddi sphincter. Materials and methods: 100 patients after cholelithiasis surgery were divided into two groups: 1 - group (main) - 86 patients after cholecystectomy; 2 - group (comparison) - 14 patients after cholecystectomy with drainage choledoch operations. The dynamics of bile flow was assessed by hepatobiliscintigraphy on a gamma camera using the radiopharmaceutical 99Tc-bromide for 90 minutes with choleretic test. Clinical manifestations, results of laboratory, ultrasound, x-ray and endoscopic examinations were analyzed. Results. According to hepatobiliscintigraphy, 20 (23, 2%) patients of group 1 had normal bile flow dynamics. 66 (76,8%) patients indicators of hepatobiliscintigraphy consistent with premature and accelerated galeotto, identical figures in the 2nd group, where 100% is set, the insufficiency of the sphincter of Oddi. Scintigraphic indicators of Oddi sphincter insufficiency correlated with signs of functional disorders of the duodenum (r=0.57, p <0.001) and duodenogastric reflux (r= 0.74, p<0.01), as well as with radiological signs of duodenal dyskinesia (r= 0.73; p<0.01). In 73% of patients of group 1 with Oddi sphincter insufficiency and 86% - in the comparison group, diarrhea was observed, against 10% with normal bile passage (p<0.0001). Drug therapy of these disorders was supplemented with prokinetics. Conclusion. Oddi sphincter insufficiency after cholecystectomy develops in 77% of cases and acquires the most pronounced clinical significance in patients with duodenal dyskinesia. The relationship of functional disorders of the biliary tract and duodenum should be considered when choosing a therapeutic tactic, supplementing therapy with drugs that regulate intestinal motility.