Marks J M, Bower A L, Goormastic M, Malycky J L, Ponsky J L
Department of Surgery, Minimally Invasive Surgery Center, E-32, The Cleveland Clinic Foundation, 9500 Euclid Avenue, 44195, Cleveland, OH, USA.
Am J Surg. 2001 Jan;181(1):60-4. doi: 10.1016/s0002-9610(00)00529-8.
Botulinum toxin A (Botox) functionally paralyzes the sphincter of Oddi in both animals and humans, resulting in reduced pressures. No study, however, has specifically addressed common bile duct (CBD) pressures after Botox injection into the sphincter of Oddi with regard to treating biliary leaks and fistulae. The goals of this present study are to compare, versus biliary stenting, the change in CBD pressures after Botox injection into the sphincter of Oddi, as well as to evaluate the timing of onset and duration of these effects on sphincteric relaxation.
After midline laparotomy in 20 mongrel dogs, a pediatric umbilical catheter was inserted into the CBD via a small cholecystotomy and attached to a water-perfused pressure transducer. After baseline CBD pressure readings, a lateral duodenotomy was performed. A total of 100 units of Botox was injected with an endoscopic sclerotherapy needle into all four quadrants of the ampulla. The dogs were randomly divided into four groups to undergo repeat laparotomy at either postoperative day 1 (group I), postoperative day 3 (group II), postoperative day 7 (group III), or postoperative day 14 (group IV). At the time of second laparotomy, a pressure-sensing catheter was reinserted into the CBD and pressures recorded. Each dog then underwent transpapillary biliary stenting with a 7 Fr. x 5 cm Cotton-Leung biliary stent and CBD pressures were again recorded.
CBD pressures were significantly lower as compared with baseline for all groups after Botox injection and after biliary stenting (P <0.001) In addition, no significant differences in the degree of CBD pressure reduction were identified between groups I through IV after Botox injection. The measured decrease in CBD pressure from baseline after Botox injection as compared with biliary stenting was significantly different for groups I and II (P <0.05) but not for groups III and IV.
Botox injection into the sphincter of Oddi results in significant CBD pressure reduction within 24 hours and continues for 14 days. Also, after postoperative day 3, there is no significant difference in the reduction of CBD pressure from baseline between Botox injection and biliary stenting. Based on these findings, Botox injection into the sphincter of Oddi may be a beneficial alternative to biliary stenting for the treatment of biliary leaks and fistulae.
肉毒杆菌毒素A（保妥适）在动物和人类中均可使奥迪括约肌功能性麻痹，从而导致压力降低。然而，尚无研究专门探讨在注射肉毒杆菌毒素至奥迪括约肌以治疗胆漏和胆瘘方面，胆总管（CBD）压力的变化情况。本研究的目的是比较肉毒杆菌毒素注射至奥迪括约肌后与胆管支架置入术相比，CBD压力的变化，以及评估这些对括约肌松弛作用的起效时间和持续时间。
对20只杂种犬行正中剖腹术后，经小胆囊切口将小儿脐导管插入CBD，并连接至水灌注压力传感器。在记录CBD压力基线读数后，行十二指肠外侧切开术。用内镜硬化治疗针向壶腹的所有四个象限注射总共100单位的保妥适。将犬随机分为四组，分别在术后第1天（I组）、术后第3天（II组）、术后第7天（III组）或术后第14天（IV组）接受再次剖腹手术。在第二次剖腹手术时，将压力传感导管重新插入CBD并记录压力。然后每只犬接受经乳头胆管支架置入术，使用7Fr.×5cm的Cotton-Leung胆管支架，并再次记录CBD压力。
与基线相比，所有组在注射肉毒杆菌毒素后和胆管支架置入术后CBD压力均显著降低（P<0.001）。此外，I组至IV组在注射肉毒杆菌毒素后，CBD压力降低程度无显著差异。与胆管支架置入术相比，I组和II组注射肉毒杆菌毒素后CBD压力较基线的测量降低值有显著差异（P<0.05），但III组和IV组无差异。
向奥迪括约肌注射肉毒杆菌毒素可在24小时内使CBD压力显著降低，并持续14天。此外，术后第3天后，注射肉毒杆菌毒素与胆管支架置入术相比，CBD压力较基线的降低无显著差异。基于这些发现，向奥迪括约肌注射肉毒杆菌毒素可能是治疗胆漏和胆瘘的胆管支架置入术的有益替代方法。
