Staritz M, Ewe K, Meyer zum Büschenfelde K H
Endoscopy. 1986 Jan;18(1):14-6. doi: 10.1055/s-2007-1018313.
The sphincter of Oddi was investigated before, immediately after and 6 weeks after endoscopic sphincterotomy by endoscopic inspection, ERCP manometry, and by X-ray following retrograde cholangiography in 14 patients presenting with bile duct stones. The sphincter motility was normal before sphincterotomy. Following electrocautery no sphincter motility was noted, the sphincter baseline pressure showed considerable interindividual changes, and the length of the residual sphincter seemed to be only slightly reduced from 14.1 mm (before) to 10.9 mm. Despite this fact, bile duct concrements of more than 10 mm in diameter could be extracted without difficulty in all patients, confirming the adequacy of the sphincterotomy. Six weeks after sphincterotomy the sphincter length was 1.9 mm (0 to 7 mm) and in 6 patients the sphincter was completely incompetent, as demonstrated by the bile duct pressure (0 mmHg) and aerocholia, in the remaining 8 patients a small residual sphincter was able to maintain sphincter patency. We conclude that ERCP manometry cannot serve to confirm completeness of sphincterotomy immediately after electrocautery. But it would be possible to perform "semisphincterotomy" by assessing the sphincter length before cutting. Since sphincterotomy causes sphincter incompetence only in some patients, ERCP manometry would be a reliable aid for classifying the patients for follow-up studies.
对14例胆管结石患者在进行内镜括约肌切开术前、术后即刻及术后6周，通过内镜检查、内镜逆行胰胆管造影（ERCP）测压以及逆行胆管造影后的X线检查，对奥迪括约肌进行了研究。括约肌切开术前括约肌运动正常。电灼后未观察到括约肌运动，括约肌基础压力显示个体间有显著变化，残余括约肌长度似乎仅从14.1mm（术前）略有缩短至10.9mm。尽管如此，所有患者均能顺利取出直径超过10mm的胆管结石，证实了括约肌切开术的充分性。括约肌切开术后6周，括约肌长度为1.9mm（0至7mm），6例患者括约肌完全功能不全，胆管压力（0mmHg）和气胆显示了这一点，其余8例患者中，一小部分残余括约肌能够维持括约肌通畅。我们得出结论，ERCP测压不能用于确认电灼后括约肌切开术的完整性。但通过在切开前评估括约肌长度来进行“半括约肌切开术 ”是可行的。由于括约肌切开术仅在部分患者中导致括约肌功能不全，ERCP测压将是对患者进行随访研究分类的可靠辅助手段。
