Cicala M, Habib F I, Vavassori P, Pallotta N, Schillaci O, Costamagna G, Guarino M P L, Scopinaro F, Fiocca F, Torsoli A, Corazziari E
DPT Gastroenterologia, Università Campus Bio-Medico Roma, Italy.
Gut. 2002 May;50(5):665-8. doi: 10.1136/gut.50.5.665.
Sphincter of Oddi dysfunction is diagnosed at manometry and, after cholecystectomy, non-invasively at quantitative choledochoscintigraphy. Patients may benefit from endoscopic sphincterotomy.
The aim of this study was to assess the usefulness of choledochoscintigraphy compared with manometry in predicting outcome of sphincterotomy in post cholecystectomy patients with sphincter of Oddi dysfunction.
Thirty patients with biliary-type pain complying with the Rome diagnostic criteria of sphincter of Oddi dysfunction and belonging to biliary group I and II were subjected to clinical evaluation, choledochoscintigraphic assessment of the hepatic hilum-duodenum transit time, endoscopic retrograde cholangiopancreatography, and perendoscopic manometry. Twenty two biliary group I and II patients with prolonged hepatic hilum-duodenum transit times were invited to undergo sphincterotomy. Fourteen patients underwent sphincterotomy; eight refused. Clinical and scintigraphic assessments were performed at follow up.
Hepatic hilum-duodenum transit time was delayed in all patients with manometric evidence of sphincter of Oddi dysfunction, in all biliary group I patients and in 64% of biliary group II patients. At follow up, all patients who underwent sphincterotomy were symptom free and hepatic hilum-duodenum transit time had either normalised or significantly improved. A favourable post sphincterotomy outcome was predicted in 93% of cases at choledochoscintigraphy and in 57% at manometry.
Quantitative choledochoscintigraphy is a useful and non-invasive test to diagnose sphincter of Oddi dysfunction as well as a reliable predictor of sphincterotomy outcome in post cholecystectomy biliary group I and II patients, irrespective of clinical classification and manometric findings.
Oddi括约肌功能障碍通过测压进行诊断，在胆囊切除术后则通过定量胆管闪烁造影进行无创诊断。患者可能从内镜括约肌切开术中获益。
本研究旨在评估胆管闪烁造影与测压相比，在预测胆囊切除术后Oddi括约肌功能障碍患者括约肌切开术结局方面的效用。
30例符合Oddi括约肌功能障碍罗马诊断标准且属于胆管I组和II组的胆源性疼痛患者接受了临床评估、肝门-十二指肠转运时间的胆管闪烁造影评估、内镜逆行胰胆管造影及经内镜测压。邀请了22例肝门-十二指肠转运时间延长的胆管I组和II组患者接受括约肌切开术。14例患者接受了括约肌切开术；8例拒绝。随访时进行了临床和闪烁造影评估。
所有经测压证实存在Oddi括约肌功能障碍的患者、所有胆管I组患者及64%的胆管II组患者的肝门-十二指肠转运时间均延迟。随访时，所有接受括约肌切开术的患者均无症状，且肝门-十二指肠转运时间已恢复正常或显著改善。胆管闪烁造影预测括约肌切开术后良好结局的准确率为93%，测压为57%。
定量胆管闪烁造影是诊断Oddi括约肌功能障碍的一种有用且无创的检查方法，也是胆囊切除术后胆管I组和II组患者括约肌切开术结局的可靠预测指标，与临床分类和测压结果无关。
