Hogan W J, Geenen J E
GI Diagnostic Labs, Medical College of Wisconsin, Milwaukee.
Endoscopy. 1988 Aug;20 Suppl 1:179-83. doi: 10.1055/s-2007-1018172.
Delivery of bile into the duodenum involves a series of complex interrelationships between hepatic secretion of bile and pressure differentials generated within the gallbladder, cystic duct and sphincter of Oddi. Theoretically, functional disorders of bile flow may arise from a disturbance of any one of the above factors. A brief review of our present knowledge of the physiology of bile flow and the spectrum of functional biliary tract disorders will be outlined to help explain possible factors which may be involved in biliary tract dysmotility disturbances. The sphincter of Oddi (SO) mechanism is dedicated to maintaining a low pressure system within the hepatic ducts which allows hepatic secretion to proceed irrespective of bile flow rate. Partial obstruction at the SO segment can give rise to intermittent or persistent upper abdominal pain. We classify sphincter of Oddi (SO) motor dysfunction into two broad categories: 1. SO stenosis: defined as a structural narrowing of part or all of the SO segment, and 2) SO dyskinesia: defined as a primary disorder of SO tonic/phasic motor activity. We have attempted to deal with an overlap in etiology of SO motor dysfunction by developing patient group classifications. Biliary I-patients with biliary-type pain, abnormal liver function tests (SGOT; al PO4 greater than 2 x normal) documented on 2 or more occasions, delayed drainage of ERCP contrast greater than 45 min, and dilated CBD greater than 12 mm diameter; Biliary II-patients with biliary-type pain but only 1 or 2 of the above criteria; Biliary III-patients with only biliary-type pain and no other abnormalities. A few of these patients may have primary SO dyskinesia.
胆汁排入十二指肠涉及胆汁的肝脏分泌与胆囊、胆囊管和Oddi括约肌内产生的压力差之间一系列复杂的相互关系。理论上，胆汁流动的功能障碍可能源于上述任何一个因素的紊乱。本文将简要回顾我们目前对胆汁流动生理学的认识以及功能性胆道疾病的范围，以帮助解释可能与胆道运动障碍有关的因素。Oddi括约肌（SO）机制致力于在肝管内维持一个低压系统，使肝脏分泌不受胆汁流速的影响而继续进行。SO段的部分梗阻可引起间歇性或持续性上腹部疼痛。我们将Oddi括约肌（SO）运动功能障碍分为两大类：1. SO狭窄：定义为SO段部分或全部的结构性狭窄；2）SO运动障碍：定义为SO张力/相位运动活动的原发性障碍。我们试图通过制定患者分组分类来处理SO运动功能障碍病因的重叠问题。胆汁I型患者有胆汁型疼痛，肝功能检查异常（SGOT；碱性磷酸酶大于正常上限2倍）在2次或更多次检查中记录，ERCP造影剂引流延迟大于45分钟，胆总管直径大于12mm；胆汁II型患者有胆汁型疼痛，但仅符合上述标准中的1或2项；胆汁III型患者仅有胆汁型疼痛且无其他异常。这些患者中有少数可能患有原发性SO运动障碍。
