Fullarton G M, Hilditch T, Campbell A, Murray W R
University Department of Surgery, Western Infirmary, Glasgow.
Gut. 1990 Feb;31(2):231-5. doi: 10.1136/gut.31.2.231.
Postcholecystectomy pain caused by sphincter of Oddi dysfunction remains a difficult condition to treat. Endoscopic sphincterotomy has been recommended for those patients with confirmed sphincter of Oddi motor abnormalities. We have studied sphincter of Oddi dysfunction patients to evaluate the effects of endoscopic sphincterotomy on both clinical symptoms and previously reported scintigraphic parameters to determine the efficacy of this method of treatment. Nine postcholecystectomy patients (seven women: two men, median age 59 years) with clinical and manometric evidence of sphincter of Oddi dysfunction underwent endoscopic sphincterotomy for persisting biliary type pain. Each patient had scintigraphy before and eight weeks after endoscopic sphincterotomy. The patients symptomatic response was assessed independently at three monthly intervals after endoscopic sphincterotomy. Scintigraphic analysis showed that the TMAX (time in minutes to maximum counts) was significantly reduced from 25.0 (20-36) (median [range]) before endoscopic sphincterotomy to 15.0 (13-25) after endoscopic sphincterotomy (p less than 0.01). Seven of nine (78%) sphincter of Oddi dysfunction patients had significant improvement in their symptoms after a mean follow up period of 12 months (range 6-19) although only six of nine were totally pain free. These results suggest that endoscopic sphincterotomy in manometrically confirmed sphincter of Oddi dysfunction improves bile drainage as measured by quantitative cholescintigraphy and is associated with at least short term symptom relief in the majority of patients.
由Oddi括约肌功能障碍引起的胆囊切除术后疼痛仍然是一种难以治疗的病症。对于那些经证实存在Oddi括约肌运动异常的患者，推荐进行内镜括约肌切开术。我们对Oddi括约肌功能障碍患者进行了研究，以评估内镜括约肌切开术对临床症状和先前报道的闪烁扫描参数的影响，从而确定这种治疗方法的疗效。9例胆囊切除术后患者（7名女性，2名男性，中位年龄59岁），有Oddi括约肌功能障碍的临床和测压证据，因持续性胆绞痛接受了内镜括约肌切开术。每位患者在接受内镜括约肌切开术前和术后8周均进行了闪烁扫描。在内镜括约肌切开术后，每隔三个月独立评估患者的症状反应。闪烁扫描分析显示，TMAX（达到最大计数的时间，以分钟计）从内镜括约肌切开术前的25.0（20 - 36）（中位数[范围]）显著降至术后的15.0（13 - 25）（p < 0.01）。9例Oddi括约肌功能障碍患者中有7例（78%）在平均随访12个月（范围6 - 19个月）后症状有显著改善，尽管9例中只有6例完全无痛。这些结果表明，对于经测压证实的Oddi括约肌功能障碍患者，内镜括约肌切开术可改善胆汁引流（通过定量胆闪烁扫描测量），并且在大多数患者中至少能带来短期症状缓解。
