Shaffer E A, Hershfield N B, Logan K, Kloiber R
Gastroenterology. 1986 Mar;90(3):728-33. doi: 10.1016/0016-5085(86)91130-3.
Unexplained abdominal pain after cholecystectomy has been attributed to sphincter of Oddi dysfunction, but no objective diagnostic criteria exist. Biliary excretion was quantitated by computer-assisted cholescintigraphy in 35 postcholecystectomy controls without symptoms, 9 patients with suspected sphincter of Oddi dysfunction (studied before and after sphincterotomy), and 18 patients with overt cholestasis from other causes (6 with extrahepatic obstruction and 12 with parenchymal liver disease). In patients with sphincter of Oddi dysfunction or with cholestasis, the time to attain maximal activity in the biliary system was significantly (p less than 0.05) longer, the percent of radiotracer excreted at 45, 60, and 90 min was less, and the emptying rate was slower compared with the controls. Cholecystokinin (0.02 U/kg X min) did not abolish biliary output, excluding a paradoxical response of the sphincter. After sphincterotomy, biliary activity peaked earlier and the percent excreted at 45 min increased but did not revert to normal. Relief of symptoms occurred in 8 of 9 patients. The one failure had normal emptying characteristics before sphincterotomy, and did not change after surgery. Another developed recurrent pain and a corresponding deterioration in biliary emptying on serial scans. Thus, functional obstruction at the sphincter of Oddi exists, is not due to any paradoxical response to cholecystokinin, and in the absence of overt cholestasis, can be detected by quantitative cholescintigraphy. Successful sphincterotomy may not completely restore biliary emptying to normal.
胆囊切除术后不明原因的腹痛一直被归因于Oddi括约肌功能障碍，但目前尚无客观的诊断标准。通过计算机辅助胆系闪烁显像对35例无症状的胆囊切除术后对照者、9例疑似Oddi括约肌功能障碍的患者（在括约肌切开术前和术后进行研究）以及18例由其他原因导致的明显胆汁淤积患者（6例肝外梗阻和12例实质性肝病患者）的胆汁排泄进行了定量分析。在Oddi括约肌功能障碍或胆汁淤积患者中，胆系达到最大活性的时间显著更长（p<0.05），45、60和90分钟时排泄的放射性示踪剂百分比更低，与对照组相比排空率更慢。胆囊收缩素（0.02 U/kg×min）并未消除胆汁排出，排除了括约肌的矛盾反应。括约肌切开术后，胆汁活性更早达到峰值，45分钟时排泄的百分比增加，但未恢复正常。9例患者中有8例症状缓解。1例失败患者在括约肌切开术前排空特征正常，术后未改变。另1例患者出现复发性疼痛，连续扫描显示胆汁排空相应恶化。因此，Oddi括约肌存在功能性梗阻，并非由于对胆囊收缩素的任何矛盾反应，在没有明显胆汁淤积的情况下，可通过定量胆系闪烁显像检测到。成功的括约肌切开术可能无法完全使胆汁排空恢复正常。
