Morgan Katherine A, Glenn Joshua B, Byrne T Karl, Adams David B
Section of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
Surg Obes Relat Dis. 2009 Sep-Oct;5(5):571-5. doi: 10.1016/j.soard.2008.12.009. Epub 2009 Feb 21.
Patients who have undergone Roux-en-Y gastric bypass for morbid obesity may develop postoperative abdominal pain disorders that require surgical evaluation. Chronic pancreatitis and pain associated with sphincter of Oddi dysfunction (SOD) is an uncommon disorder whose clinical diagnosis is problematic without sphincter of Oddi manometry. To evaluate the diagnosis and treatment of SOD in the gastric bypass population, a retrospective review and analysis of gastric bypass patients who had undergone transduodenal sphincteroplasty (TS) for SOD was undertaken.
The medical records of patients who had undergone TS after gastric bypass at the Medical University of South Carolina Digestive Disease Center from January 2002 to December 2006 were evaluated for outcomes-based data with the approval of the institutional review board for the evaluation of human subjects. Long-term patient outcomes were assessed using the Medical Outcomes Study Short Form 36-item, version 2, quality-of-life survey.
A total of 16 women (median age 49 years) were identified who had undergone TS with biliary sphincteroplasty and pancreatic ductal septoplasty for SOD. The indications for surgery included pain (100%), nausea (31%), weight loss (13%), and recurrent pancreatitis (31%). The diagnosis of SOD was supported by magnetic resonance cholangiopancreatography with secretin stimulation. Three postoperative complications (18.8%) developed, but no mortality. The average length of hospital stay was 5 days (range 2-9). Of the 16 patients, 13 (81%) responded to the survey follow-up. The mean length of follow-up was 28 months (range 16-57). Of the 13 patients, 11 (85%) reported pain improvement after surgery. The survey's norm-based scores were similar to those of a representative population.
SOD should be considered in the differential diagnosis of gastric bypass patients with pancreatobiliary pain after cholecystectomy. When the clinical history is supported by laboratory and magnetic resonance cholangiopancreatography data, TS can be undertaken with low morbidity and good patient outcomes. SOD is a notable disorder in the gastric bypass population. With appropriate patient selection, TS can be beneficial.
因病态肥胖接受 Roux-en-Y 胃旁路手术的患者可能会出现需要手术评估的术后腹痛病症。慢性胰腺炎以及与Oddi括约肌功能障碍（SOD）相关的疼痛是一种罕见病症，在没有进行Oddi括约肌测压的情况下，其临床诊断存在问题。为了评估胃旁路手术人群中SOD的诊断和治疗情况，对因SOD接受经十二指肠括约肌成形术（TS）的胃旁路手术患者进行了回顾性研究和分析。
在南卡罗来纳医科大学消化疾病中心，对2002年1月至2006年12月期间接受胃旁路手术后又接受TS的患者的病历进行评估，以获取基于结果的数据，该评估经机构审查委员会批准，用于对人类受试者的评估。使用医学结果研究简表36项第2版生活质量调查问卷评估患者的长期预后。
共确定了16名女性（中位年龄49岁），她们因SOD接受了胆管括约肌成形术和胰管间隔成形术的TS。手术指征包括疼痛（100%）、恶心（31%）、体重减轻（13%）和复发性胰腺炎（31%）。SOD的诊断得到了磁共振胰胆管造影加促胰液素刺激的支持。发生了3例术后并发症（18.8%），但无死亡病例。平均住院时间为5天（范围2 - 9天）。16名患者中有13名（81%）对调查随访做出了回应。平均随访时间为28个月（范围16 - 57个月）。13名患者中有11名（85%）报告术后疼痛有所改善。该调查基于常模的评分与代表性人群的评分相似。
对于胆囊切除术后出现胰胆疼痛的胃旁路手术患者，鉴别诊断时应考虑SOD。当临床病史得到实验室和磁共振胰胆管造影数据支持时，可进行TS，其发病率低且患者预后良好。SOD在胃旁路手术人群中是一种值得关注的病症。通过适当选择患者，TS可能有益。
