Thune A, Saccone G T, Scicchitano J P, Toouli J
Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia.
Gut. 1991 Jun;32(6):690-3. doi: 10.1136/gut.32.6.690.
Studies in animals have suggested a neural reflex between the gall bladder and the sphincter of Oddi. The aim of this study was to investigate whether sphincter of Oddi motility is altered by distension of the gall bladder in humans. Sphincter of Oddi motility was recorded intraoperatively in 10 patients undergoing elective cholecystectomy for gall stones. The manometry was performed by a triple lumen constantly perfused catheter which was introduced through the cystic duct and positioned across the sphincter of Oddi to record sphincter basal pressure, wave amplitude, and frequency of contractions. In five patients a separate catheter was introduced into the gall bladder after ligation of the cystic duct. This catheter was used to distend the gall bladder. Sphincter of Oddi pressures were measured before, during, and after the distension. In a separate control group of patients (n = 5) basal sphincter of Oddi activity was recorded without distension of the gall bladder. Distension of the gall bladder decreased sphincter of Oddi basal pressure from (mean (SD] 22.8 (8.5) mmHg to 18.6 (6.5) mmHg (p = 0.01, paired t test) and frequency of sphincter of Oddi contractions decreased from 2.6 (1.6) to 1.1 (1.3) contractions/min (p = 0.003, paired t test). The results were significantly different from those of the control group (p less than 0.05, unpaired t test) during the same time period (four minutes). Pulse rate and blood pressure were not affected by the gall bladder distension. The results suggest a local reflex between the gall bladder and the sphincter of Oddi that might be important in the regulation of the pressure within the bile ducts and flow across the sphincter. This reflex is likely to be neurally mediated and injuries to it may be important in the aetiology of postcholecystectomy sphincter of Oddi dysfunction.
对动物的研究表明，胆囊与奥迪括约肌之间存在神经反射。本研究的目的是调查在人类中，胆囊扩张是否会改变奥迪括约肌的运动。对10例因胆结石接受择期胆囊切除术的患者在术中记录奥迪括约肌的运动。通过一根三腔持续灌注导管进行测压，该导管经胆囊管插入并跨过奥迪括约肌放置，以记录括约肌基础压力、波幅和收缩频率。在5例患者中，在结扎胆囊管后，将另一根导管插入胆囊。该导管用于扩张胆囊。在扩张前、扩张期间和扩张后测量奥迪括约肌压力。在另一组单独的对照组患者（n = 5）中，在不扩张胆囊的情况下记录奥迪括约肌的基础活动。胆囊扩张使奥迪括约肌基础压力从（均值[标准差]）22.8（8.5）mmHg降至18.6（6.5）mmHg（p = 0.01，配对t检验），奥迪括约肌收缩频率从2.6（1.6）次/分钟降至1.1（1.3）次/分钟（p = 0.003，配对t检验）。在同一时间段（4分钟）内，结果与对照组显著不同（p < 0.05，非配对t检验）。脉搏率和血压不受胆囊扩张的影响。结果表明胆囊与奥迪括约肌之间存在局部反射，这可能在胆管内压力调节和通过括约肌的胆汁流动调节中起重要作用。这种反射可能由神经介导，对其的损伤可能在胆囊切除术后奥迪括约肌功能障碍的病因学中起重要作用。
