Linder Jeffrey D, Geels Wilma, Wilcox C Mel
Department of Medicine, Division of Gastroenterology & Hepatology, University of Alabama at Birmingham, 35294-0007, USA.
Dig Dis Sci. 2002 Nov;47(11):2411-5. doi: 10.1023/a:1020611302852.
Recent studies suggest a high prevalence of sphincter of Oddi dysfunction (SOD) in patients referred to specialized centers for sphincter of Oddi manometry (SOM). Whether these results can be generalized to other centers is unknown. From September 1998 to April 2000, patients undergoing SOM were prospectively identified. Patients were classified as having either biliary or pancreatic SOD, according to the modified Milwaukee classification, and underwent SOM of either the biliary or pancreatic sphincter based on clinical history. SOD was diagnosed when the mean basal sphincter pressure was >40 mm Hg. Standard cholangiography and/or pancreatography were performed following manometry. Fifty-one patients were studied (43 women, median age 46 years, range 7-74 years). Prior to SOM, patients were classified by the modified Milwaukee classification as biliary type I in 1 patient, type II in 8, and type III in 20; pancreatic type I in 4 patients, type II in 14, and type III in 3; and biliary type III and pancreatic type III in 1 patient. Indications for SOM included abdominal pain in 35 patients (69%), recurrent idiopathic pancreatitis in 12 (24%), chronic pancreatitis in 3 (7%), and acute pancreatitis in 1 (2%). Overall, 30 patients (59%; 95% CI 41.1-76.9%) were found to have SOD; abnormal biliary sphincter pressure in 16 of 29 patients (55%) undergoing biliary manometry, and abnormal pancreatic sphincter pressures in 14 of 21 patients (67%) undergoing pancreatic sphincter manometry, and abnormal biliary and pancreatic sphincter pressures in 1. SOD was diagnosed in 1 biliary type I patient (100%), 4 type II patients (50%), and 11 type III patients (52.4%) with a mean pressures of 92, 47, and 80 mm Hg, respectively. SOD was identified in 4 pancreatic type I patients (100%), 7 type II patients (50%), and 3 type III patients (100%) with mean sphincter pressures of 83 mm Hg, 96 mm Hg, and 102 mm Hg, respectively. In conclusion, the prevalence of SOD in patients with suspected biliary disease was 55%, suspected pancreatic disease 66%, yielding an overall prevalence of SOD of 59%. These results confirm the high prevalence of SOD in patients referred for SOM.
近期研究表明，在因行Oddi括约肌测压（SOM）而被转诊至专业中心的患者中，Oddi括约肌功能障碍（SOD）的患病率较高。这些结果能否推广至其他中心尚不清楚。1998年9月至2000年4月，对接受SOM的患者进行前瞻性识别。根据改良的密尔沃基分类法，将患者分为胆汁性或胰腺性SOD，并根据临床病史对胆汁或胰腺括约肌进行SOM。当平均基础括约肌压力>40 mmHg时，诊断为SOD。测压后进行标准胆管造影和/或胰管造影。共研究了51例患者（43例女性，中位年龄46岁，范围7 - 74岁）。在SOM之前，根据改良的密尔沃基分类法，1例患者为胆汁性I型，8例为II型，20例为III型；4例患者为胰腺性I型，14例为II型，3例为III型；1例患者为胆汁性III型和胰腺性III型。SOM的适应证包括35例患者（69%）的腹痛、12例（24%）的复发性特发性胰腺炎、3例（7%）的慢性胰腺炎和1例（2%）的急性胰腺炎。总体而言，30例患者（59%；95%可信区间41.1 - 76.9%）被发现患有SOD；29例行胆汁测压的患者中有16例（55%）胆汁括约肌压力异常，21例行胰腺括约肌测压的患者中有14例（67%）胰腺括约肌压力异常，1例患者胆汁和胰腺括约肌压力均异常。1例胆汁性I型患者（100%）、4例II型患者（50%）和11例III型患者（52.4%）被诊断为SOD，平均压力分别为92 mmHg、47 mmHg和80 mmHg。4例胰腺性I型患者（100%）、7例II型患者（50%）和3例III型患者（100%）被发现患有SOD，平均括约肌压力分别为83 mmHg、96 mmHg和102 mmHg。总之，疑似胆汁疾病患者中SOD的患病率为55%，疑似胰腺疾病患者中为66%，SOD的总体患病率为59%。这些结果证实了因SOM而转诊的患者中SOD的高患病率。
