Sherman S, Hawes R H, Troiano F P, Lehman G A
Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis.
Gastrointest Endosc. 1992 May-Jun;38(3):347-50. doi: 10.1016/s0016-5107(92)70430-1.
The aspirating sphincter of Oddi manometry (SOM) catheter was shown to reduce the frequency of post-procedure pancreatitis from 31% to 4% following a pancreatic duct evaluation. This study was designed to prospectively evaluate the utility of the aspirating manometry catheter in reducing the frequency of pancreatic enzyme elevation and clinical pancreatitis following isolated bile duct manometry. Thirty-eight patients were randomly assigned to undergo bile duct SOM with the standard perfusion (infused group) catheter or the aspirating catheter (aspirated group). Overall, the frequency of both amylase and lipase level elevation at least two times the upper limits of normal was 30% at 2 hours, 25% at 6 hours, and 18% at 18 hours after the procedure and was similar for the aspirated and infused groups. No episodes of clinical pancreatitis occurred in either group. The SOM catheter was perfused with full-strength contrast in 12 consecutive patients undergoing a bile duct evaluation. Only one patient had any contrast material identified in the pancreatic duct. The results of this study support the theory that increased pancreatic duct hydrostatic pressure is the major cause for post-SOM pancreatitis and suggests that SOM evaluation of the bile duct alone appears to be safe.
在一项胰管评估后，Oddi括约肌测压（SOM）抽吸导管可将术后胰腺炎的发生率从31%降至4%。本研究旨在前瞻性评估抽吸测压导管在降低单纯胆管测压后胰酶升高频率和临床胰腺炎发生率方面的效用。38例患者被随机分配接受使用标准灌注（灌注组）导管或抽吸导管（抽吸组）进行胆管SOM。总体而言，术后2小时淀粉酶和脂肪酶水平至少升高至正常上限两倍的频率为30%，6小时为25%，18小时为18%，抽吸组和灌注组相似。两组均未发生临床胰腺炎。在12例连续接受胆管评估的患者中，SOM导管用全强度造影剂灌注。仅1例患者在胰管中发现有造影剂。本研究结果支持以下理论，即胰管静水压升高是SOM术后胰腺炎的主要原因，并表明单纯胆管SOM评估似乎是安全的。
