Masoni L, Buccino R V, Miscusi G, Montori A
III Cattedra Patologia Speciale Chirurgica, Università degli Studi di Roma La Sapienza, Italy.
Surg Endosc. 1988;2(2):59-65. doi: 10.1007/BF00704351.
To verify the appropriateness of sphincterotomy as the treatment of choice of choledocholithiasis, since 1980 we have been using endoscopic retrograde cholangiopancreatographic (ERCP) manometry of the sphincter of Oddi (SO). This method allows direct investigation of SO motor activity and provides useful information regarding the presence of benign papillary stenosis (BPS). Thirty-four patients were investigated because the radiological examination indicated BPS might be present. Of these, 20 had common bile duct (CBD) stones, while the remaining 14 presented with biliarylike pain and one or more of the following: CBD dilation (larger than 12 mm); emptying of the ERCP contrast medium took longer than 45 min; abnormal liver function tests. Moreover, 8 healthy volunteers served as controls. Our results show that the incidence of SO motor anomalies is very low in the presence of choledocholithiasis, while it is substantial in patients with suspected SO dysfunction. These observations would suggest that, unlike the traditional view, BPS is rarely secondary to biliary lithiasis. Therefore, most of the sphincterotomies performed that are based on the assumption of underlying SO pathology should be considered unnecessary. Under these circumstances, the physiological role of a functioning SO has induced us to advocate sphincterotomy, surgical or endoscopic, in selected cases only.
为验证括约肌切开术作为胆总管结石首选治疗方法的合理性，自1980年以来，我们一直在使用内镜逆行胰胆管造影术（ERCP）对Oddi括约肌（SO）进行测压。该方法可直接研究SO的运动活性，并提供有关良性乳头狭窄（BPS）存在的有用信息。34例患者因影像学检查提示可能存在BPS而接受了检查。其中，20例有胆总管（CBD）结石，其余14例表现为胆绞痛样疼痛，并伴有以下一种或多种情况：CBD扩张（大于12mm）；ERCP造影剂排空时间超过45分钟；肝功能检查异常。此外，8名健康志愿者作为对照。我们的结果表明，胆总管结石患者中SO运动异常的发生率非常低，而疑似SO功能障碍的患者中发生率较高。这些观察结果表明，与传统观点不同，BPS很少继发于胆石症。因此，大多数基于潜在SO病变假设而进行的括约肌切开术应被认为是不必要的。在这种情况下，功能正常的SO的生理作用促使我们主张仅在特定病例中进行手术或内镜括约肌切开术。
