Toouli James
Professor of Surgery, Flinders University of South Australia, Flinders Medical Centre, Bedford, Park, South Australia 5042, Australia.
Curr Treat Options Gastroenterol. 2002 Aug;5(4):285-291. doi: 10.1007/s11938-002-0051-9.
Biliary dyskinesia is a motility disorder that affects the gallbladder and sphincter of Oddi. The motility disorder of the gallbladder is called gallbladder dyskinesia. Patients with this condition present with biliary-type pain, and investigations show no evidence of gallstones in the gallbladder. The diagnosis is made by performing a gallbladder ejection fraction, which is a radionuclide investigation. An abnormal gallbladder ejection fraction has a value less than 40%. Patients with an abnormal gallbladder ejection fraction should undergo cholecystectomy. This procedure has been shown to be effective in curing the symptoms in over 90% of patients. Motility disorder of the sphincter of Oddi is called sphincter of Oddi dysfunction. This disorder is categorized as two distinct types--biliary sphincter of Oddi dysfunction and pancreatic sphincter of Oddi dysfunction. Typically, patients with biliary sphincter of Oddi dysfunction present with biliary-type pain on average 4 to 5 years after having undergone cholecystectomy. Sphincter of Oddi manometry is essential in making a diagnosis of abnormal motility of the sphincter. On manometry, diagnosis of a sphincter of Oddi stenosis should lead to division of the sphincter. Sphincterotomy results in long-term relief of symptoms in more than 80% of patients. Pancreatic sphincter of Oddi dysfunction clinically presents with recurrent episodes of pancreatitis of unknown cause. Having ruled out all of the common causes of pancreatitis, sphincter of Oddi manometry of the pancreatic duct sphincter should be performed. When manometric stenosis is diagnosed, these patients should undergo division of both the biliary and pancreatic duct sphincter. This treatment results in relief of symptoms in more than 80% of patients.
胆囊运动障碍是一种影响胆囊和奥迪括约肌的运动功能紊乱疾病。胆囊的运动功能紊乱被称为胆囊运动障碍。患有这种疾病的患者会出现胆绞痛型疼痛，检查显示胆囊内没有胆结石的迹象。通过进行胆囊排空分数检查来做出诊断，这是一种放射性核素检查。异常的胆囊排空分数值小于40%。胆囊排空分数异常的患者应接受胆囊切除术。该手术已被证明在90%以上的患者中能有效缓解症状。奥迪括约肌运动功能紊乱被称为奥迪括约肌功能障碍。这种疾病分为两种不同类型——胆管型奥迪括约肌功能障碍和胰管型奥迪括约肌功能障碍。通常，胆管型奥迪括约肌功能障碍的患者在接受胆囊切除术后平均4至5年会出现胆绞痛型疼痛。奥迪括约肌测压对于诊断括约肌运动异常至关重要。在测压时，诊断为奥迪括约肌狭窄应进行括约肌切开术。括约肌切开术能使80%以上的患者症状得到长期缓解。胰管型奥迪括约肌功能障碍临床上表现为不明原因的复发性胰腺炎。在排除所有常见的胰腺炎病因后，应进行胰管括约肌的奥迪括约肌测压。当诊断为测压性狭窄时，这些患者应同时进行胆管和胰管括约肌切开术。这种治疗能使80%以上的患者症状得到缓解。
