Sherman S, Hawes R H, Madura J A, Lehman G A
Department of Surgery, Indiana University Medical Center, Indianapolis.
Surg Gynecol Obstet. 1992 Nov;175(5):410-8.
Despite the potential utility of intraoperative manometry of the sphincter of Oddi, limited data are available validating its use. The current study was undertaken to validate the method of intraoperative sphincter of Oddi manometry by comparing the pressure tracings obtained at operation (transduodenal sphincteroplasty and transampullary septoplasty) and endoscopy (preoperative) in the same group of patients. Seventy-four patients with idiopathic pancreatitis or unexplained disabling pancreaticobiliary pain had sphincter of Oddi manometry performed endoscopically and intraoperatively within six weeks of each other. Thirty-five patients had manometric evaluation of the bile duct segment of the sphincter of Oddi. The mean basal sphincter pressure determined endoscopically and intraoperatively was 41.1 +/- 6.4 millimeters of mercury (mean plus or minus standard error of the mean) and 42.0 +/- 6.8 millimeters of mercury (not significantly different, p > 0.05), respectively. There was no significant difference between the biliary sphincter phasic pressure, phasic frequency and phasic duration, as recorded by the two techniques. Fifty-five patients had manometric evaluation of the pancreatic duct sphincter. The mean basal sphincter pressure determined endoscopically and intraoperatively (after biliary sphincteroplasty) was 111.9 +/- 9.9 millimeters of mercury and 102.7 +/- 8.7 millimeters of mercury, respectively (not significantly different, p > 0.05). There was no significant difference in the pancreatic sphincter phasic duration and phasic frequency determined by the two techniques. However, the pancreatic sphincter phasic pressure was significantly higher when measured endoscopically (p < 0.001). Overall, 70 percent of patients benefited from surgical sphincter ablation therapy. Patients with an elevated basal sphincter pressure determined intraoperatively were more likely to improve than those with a normal basal sphincter pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
尽管术中对Oddi括约肌进行测压具有潜在用途，但验证其用途的数据有限。本研究旨在通过比较同一组患者手术时（经十二指肠括约肌成形术和经壶腹隔膜成形术）和内镜检查（术前）获得的压力曲线，来验证术中Oddi括约肌测压方法。74例特发性胰腺炎或不明原因的致残性胰胆疼痛患者在彼此相隔六周内接受了内镜和术中Oddi括约肌测压。35例患者对Oddi括约肌的胆管段进行了测压评估。内镜检查和术中测定的平均基础括约肌压力分别为41.1±6.4毫米汞柱（均值±均值标准误差）和42.0±6.8毫米汞柱（无显著差异，p>0.05）。两种技术记录的胆管括约肌相压力、相频率和相持续时间之间无显著差异。55例患者对胰管括约肌进行了测压评估。内镜检查和术中（胆管括约肌成形术后）测定的平均基础括约肌压力分别为111.9±9.9毫米汞柱和102.7±8.7毫米汞柱（无显著差异，p>0.05）。两种技术测定的胰管括约肌相持续时间和相频率无显著差异。然而，内镜测量时胰管括约肌相压力显著更高（p<0.001）。总体而言,70%的患者从手术括约肌切除治疗中受益。术中测定基础括约肌压力升高的患者比基础括约肌压力正常的患者更有可能改善。（摘要截短至250字）
