Murray William, Kong San
Lister Department of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
Scand J Gastroenterol. 2010 May;45(5):623-7. doi: 10.3109/00365521003615647.
A retrospective clinical audit was carried out to identify whether relaxation of the sphincter of Oddi (SO) by botulinum toxin (BTX) injection can select patients with episodic functional post-cholecystectomy biliary pain who will benefit from endoscopic sphincterotomy.
Sixty-four patients complaining of functional post-cholecystectomy biliary pain with a frequency of at least four episodes per month had 100 units of BTX injected into their SO muscle in four aliquots. After review patients with a pain free interval following BTX injection of at least 4 weeks were offered biliary endoscopic sphincterotomy and their outcome assessed.
Of the 64 patients 46 (72%) had at least four pain free weeks after BTX therapy and 44 of these 46 patients (96%) went on to experience pain relief following endoscopic sphincterotomy. Of the 64 patients 41 had sphincter of Oddi manometry prior to BTX injection. Every patient with sphincter of Oddi hypertension defined by manometry and at least 4 weeks' pain relief following BTX (24) had pain relief following sphincterotomy. Fifteen (94%) of the 16 patients who did not undergo manometry but reported at least 4 weeks' pain relief after BTX had pain relief after sphincterotomy.
Botulinum toxin relaxation of the SO may be a useful method of predicting the symptom response to endoscopic sphincterotomy in patients who have episodic functional biliary pain.
进行一项回顾性临床审计，以确定通过注射肉毒杆菌毒素（BTX）松弛Oddi括约肌（SO）是否可以筛选出能从内镜括约肌切开术中获益的发作性功能性胆囊切除术后胆绞痛患者。
64例主诉胆囊切除术后功能性胆绞痛且每月发作至少4次的患者，将100单位BTX分4份注射到其SO肌中。在评估后，为BTX注射后无痛间歇期至少4周的患者提供胆道内镜括约肌切开术，并评估其结果。
64例患者中，46例（72%）在BTX治疗后至少有4周无痛，这46例患者中有44例（96%）在内镜括约肌切开术后疼痛缓解。64例患者中，41例在BTX注射前行Oddi括约肌测压。通过测压定义为Oddi括约肌高压且BTX治疗后至少有4周疼痛缓解的每例患者（24例），在内镜括约肌切开术后疼痛均缓解。16例未进行测压但报告BTX治疗后至少有4周疼痛缓解的患者中，15例（94%）在内镜括约肌切开术后疼痛缓解。
对于有发作性功能性胆绞痛的患者，BTX松弛SO可能是预测内镜括约肌切开术症状反应的一种有用方法。
