Toouli J
Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia.
Aust N Z J Surg. 1989 Jun;59(6):445-8. doi: 10.1111/j.1445-2197.1989.tb01608.x.
Disorders of sphincter of Oddi motility are being recognized as a cause for post-cholecystectomy pain. Objective diagnosis of sphincter of Oddi dysfunction is difficult because of the relative inaccessibility of the sphincter. In recent years, a number of investigations have been used in order to diagnose motility disorders of the sphincter of Oddi. The most useful of these investigations is endoscopic manometry. However, in addition, the morphine neostigmine provocation test, radioscintigraphy to assess bile flow, and assessment of pancreatic duct diameter following secretin infusion have been used. Specificity and sensitivity for all of these investigations of sphincter of Oddi function have been difficult to obtain due to the small number of patients and the heterogeneity of sphincter of Oddi abnormalities. Based on the manometry measurements, two major subgroups of sphincter of Oddi dysfunction have been defined. One group of patients exhibits a high basal pressure consistent with stenosis and the second demonstrates a number of dyskinetic patterns. Prospective studies currently underway will best define the most appropriate therapy for these disorders.
Oddi括约肌运动障碍正被视为胆囊切除术后疼痛的一个原因。由于Oddi括约肌相对难以触及，对其功能障碍进行客观诊断较为困难。近年来，为了诊断Oddi括约肌运动障碍，人们采用了多种检查方法。其中最有用的检查是内镜测压法。不过，除此之外，还使用了吗啡新斯的明激发试验、评估胆汁流动的放射性核素显像以及注射促胰液素后评估胰管直径等方法。由于患者数量较少以及Oddi括约肌异常的异质性，很难获得所有这些Oddi括约肌功能检查的特异性和敏感性。基于测压测量结果，Oddi括约肌功能障碍被分为两个主要亚组。一组患者表现出与狭窄一致的高基础压力，另一组则表现出多种运动障碍模式。目前正在进行的前瞻性研究将最恰当地确定针对这些疾病的治疗方法。
