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本研究取43例19—43岁国人无胆管和胰腺疾病Vater区新鲜标本,采用组织切片,结缔组织纤维特殊染色和扫描电镀等方法,观测odd括约肌(SO)构筑、长度以及SO复合体主要成份构成比等多项指标。以为SO切开术提供依据,并对进一步探索胆管炎、胰腺炎时,常有SO持续高张力,胆、胰管内压增高等问题,作此相关性研究。结果:①SO可分为两层:内纵,外环;外层与十二指肠环肌有肌纤维联系;SO复合体中肌纤维占64.-4%。胶原纤维14.1%,网状纤维16.1%,弹性纤维5i4%。结缔组织纤维方向主要与平滑肌纤维方向一致。②壶腹中隔平滑肌为胆总管括约肌和胰管括约肌融合而成,以胆总管括约肌的环形肌束居多。③从大乳头顶至胆总管括约肌上界间距为15.6±3.14mm;自大乳头项至胆总管斜穿十二指肠肌层处间距为11.3±3.07mm;SO长13.6±3.85mm,胆总管侧粘膜皱辔上界在十二指肠墨外2.27±0.92mm;壶腹中隔基部厚1.47±0.36mm,同时测得胰管侧括约肌有关数据。据结果提示:①实施SO切开术时,在胆总管侧切口长度最好不超过12mm。建议胆总管侧粘膜级级上界作为ERCP检查和SO切开术切口长度的参考标志后对壶腹中隔基部观测,在行CT、US、X线等检查时,可作为识别中隔炎、中隔肥厚、“双管征”等参考数据。③
In this study, 43 fresh samples from 19 Vateries without bile ducts and pancreatic diseases from 19 to 43 years old were collected. The structure and length of odd sphincter (SO) and the main components of SO complex were observed by tissue sections, special staining of connective tissue fibers and scanning electroplating Composition ratio and many other indicators. To provide the basis for the incision of SO, and to further explore the cholangitis, pancreatitis, often sustained high tension SO, gallbladder, pancreatic duct pressure and other issues, for this correlation study. Results: ①SO was divided into two layers: the inner longitudinal and outer rings; the outer layer and the duodenum had muscle fibers; and the SO fibers accounted for 64 in the SO complex. -4%. 14.1% of collagen fibers, 16.1% of reticular fibers and 5i4% of elastic fibers. Connective tissue fibers mainly in the direction of smooth muscle fibers. ② ampullary septal smooth muscle for the common bile duct sphincter and pancreatic duct sphincter fusion to the majority of the common bile duct sphincter muscle bundle. ③ from the top of the big papilla to the common bile duct sphincter spacing of 15.6 ± 3.14mm; from the papillary to common bile duct duodenum through the duodenum 11.3 ± 3.07mm spacing; SO length 13 .6 ± 3.85mm, the upper common bile duct mucosa folds in the duodenum ink 2.27 ± 0.92mm; ampulla septum base thickness 1.47 ± 0.36mm, measured at the same time the pancreatic duct Sphincter data. According to the results suggest: ① the implementation of SO incision, the best side of the common bile duct incision length does not exceed 12mm. Proposed bile duct mucosa-level upper bound as ERCP examination and SO incision incision length of the reference mark after the ampulla on the base of the observation in the line CT, US, X-ray examination, can be used as identification of septal inflammation, in the Fat hypertrophy, “double sign” and other reference data. ③