Jagannath S, Kalloo A N
The Johns Hopkins Hospital, 1830 East Monument Street, Room 419, Baltimore, MD 21205, USA.
Curr Gastroenterol Rep. 2001 Apr;3(2):160-5. doi: 10.1007/s11894-001-0014-7.
Sphincter of Oddi dysfunction (SOD) can pose diagnostic challenges for the physician. SOD is classified into types I, II, and III, but clinical outcome after sphincterotomy for suspected types II and III SOD has been unpredictable. Therefore, accurate diagnosis of types II and III SOD is important because of the increased risk of sphincterotomy in patients with SOD. Endoscopic sphincter of Oddi manometry (ESOM) is the gold standard for diagnosis of SOD; however, it is associated with significant morbidity and is not an appropriate screening test. Quantitative hepatobiliary scintigraphy (QHBS) has demonstrated good sensitivity as a screening test for SOD in patients following cholecystectomy; however, studies using this methodology are criticized for poor design and patient selection. Recent publications address these criticisms and provide evidence that QHBS and ESOM are comparable diagnostic tools after exclusion of organic biliary obstruction. QHBS can effectively replace invasive ESOM in the diagnostic algorithm of SOD.
奥狄括约肌功能障碍（SOD）会给医生带来诊断挑战。SOD分为I型、II型和III型，但对于疑似II型和III型SOD患者，括约肌切开术后的临床结果一直难以预测。因此，准确诊断II型和III型SOD很重要，因为SOD患者进行括约肌切开术的风险会增加。内镜下奥狄括约肌测压（ESOM）是诊断SOD的金标准；然而，它会带来显著的发病率，且不是一种合适的筛查测试。定量肝胆闪烁扫描（QHBS）作为胆囊切除术后患者SOD的筛查测试，已显示出良好的敏感性；然而，使用这种方法的研究因设计不佳和患者选择不当而受到批评。最近的出版物回应了这些批评，并提供证据表明，在排除器质性胆道梗阻后，QHBS和ESOM是可比的诊断工具。在SOD的诊断算法中，QHBS可以有效地替代侵入性的ESOM。
