Dreiling D A, Greenstein R J
Am J Gastroenterol. 1979 Dec;72(6):665-70.
The physiology and pathophysiology of the sphincter of Oddi are poorly understood. The relationships of functional disorders of the sphincter to biliary and pancreatic disease and of organic lesions of the papilla to pancreatic inflammatory disease are subjudice to say the least. The efficacy of sphincter section in the treatment of chronic pancreatitis is unproved. Section of the sphincter may be necessary to treat biliary tract pathology but its use should not be routine or indiscriminative since, there is morbidity as well as mortality. Finally, the price of sphincterotomy is: 1. hemorrhage; 2. duodenal perforation; 3. pancreatic duct damage--a. acute pancreatitis; b. chronic pancreatitis; 4. sphincter incompetence--a. common duct regurgitation--cholangitis; b. pancreatic duct regurgitation--pancreatitis; 5. sphincter stenosis--obstructive jaundice; 6. stasis cholecystitis; 7. diarrhea; 8. morbidity 10%; 9. mortality 1.9%.
Oddi括约肌的生理和病理生理机制目前仍知之甚少。至少可以说，括约肌功能障碍与胆胰疾病之间的关系，以及乳头器质性病变与胰腺炎症性疾病之间的关系尚无定论。括约肌切开术治疗慢性胰腺炎的疗效尚未得到证实。虽然为治疗胆道疾病可能有必要进行括约肌切开，但不应将其作为常规或不加区分的治疗手段，因为该手术存在发病率和死亡率。最后，括约肌切开术的代价包括：1. 出血；2. 十二指肠穿孔；3. 胰管损伤——a. 急性胰腺炎；b. 慢性胰腺炎；4. 括约肌功能不全——a. 胆总管反流——胆管炎；b. 胰管反流——胰腺炎；5. 括约肌狭窄——梗阻性黄疸；6. 淤积性胆囊炎；7. 腹泻；8. 发病率10%；9. 死亡率1.9%。
