Hutton S W, Sievert C E, Vennes J A, Shafer R B, Duane W C
Department of Medicine, Veterans Administration Medical Center, Minneapolis, Minnesota.
Gastroenterology. 1988 Apr;94(4):1031-5. doi: 10.1016/0016-5085(88)90563-x.
To investigate the mechanism by which ablation of the sphincter of Oddi prevents gallstone formation, we assessed passage of glass beads out of the gallbladders of dogs with sphincterotomy and sham sphincterotomy. One month after bead implantation, dogs with an intact sphincter passed 52%, 26%, 22%, 10%, 0%, and 0% of beads with diameters of 2, 3, 4, 5, 6, and 8 mm, respectively. For the same respective bead diameters, dogs with a sphincterotomy passed 90%, 90%, 88%, 75%, 75%, and 42% of beads (p less than 0.05 for all bead diameters). No beads were in the common bile duct of any dog. In separate dogs studied by cholescintigraphy, sphincterotomy significantly increased gallbladder ejection fraction from 0.46 to 0.76 (p less than 0.01). In addition, sphincterotomy significantly lowered resting gallbladder volume from 24.4 to 15.8 ml (p less than 0.025) and lowered cholecystokinin-stimulated gallbladder volume from 13.3 to 5.9 ml (p less than 0.025). These data indicate that even with an intact sphincter, small solids can pass from the gallbladder and into the duodenum. Sphincterotomy facilitates passage of solids, apparently by general improvement in gallbladder emptying. Facilitated passage of crystals, microliths, or small stones seems the most likely explanation for prevention of gallstone formation by sphincterotomy.
为了研究Oddi括约肌切除术预防胆结石形成的机制，我们评估了玻璃珠在接受括约肌切开术和假括约肌切开术的犬胆囊中的排出情况。珠子植入后1个月，括约肌完整的犬排出直径为2、3、4、5、6和8mm的珠子的比例分别为52%、26%、22%、10%、0%和0%。对于相同直径的珠子，接受括约肌切开术的犬排出珠子的比例分别为90%、90%、88%、75%、75%和42%（所有珠子直径的p值均小于0.05）。所有犬的胆总管中均未发现珠子。在通过胆囊闪烁显像术研究的另一组犬中，括约肌切开术使胆囊排空分数从0.46显著提高到0.76（p值小于0.01）。此外，括约肌切开术使静息胆囊容积从24.4ml显著降低至15.8ml（p值小于0.025），并使胆囊收缩素刺激后的胆囊容积从13.3ml降低至5.9ml（p值小于0.025）。这些数据表明，即使括约肌完整，小的固体物质也能从胆囊进入十二指肠。括约肌切开术显然通过总体改善胆囊排空来促进固体物质的排出。晶体、微结石或小结石排出的促进似乎是括约肌切开术预防胆结石形成的最可能解释。
