Tanaka M, Ikeda S, Matsumoto S, Yoshimoto H, Nakayama F
Ann Surg. 1985 Dec;202(6):712-9. doi: 10.1097/00000658-198512000-00009.
Seventeen patients with postcholecystectomy pain and nine controls were studied by nonoperative biliary manometry with stimulation of sphincter of Oddi spasm by morphine. The controls remained asymptomatic despite an elevation of bile duct pressure after morphine. In 13 patients with postcholecystectomy pain, morphine induced pain paralleling a pressure rise. Three other patients had pain not paralleling a pressure change, and another showed a pressure rise without pain. None of the controls, four with the parallel pain-pressure change, and one with the discordant pain-pressure correlation were positive at the traditional morphine-Prostigmin test. Endoscopic sphincterotomy provided complete (8), moderate (3), or slight (1) relief of pain to 12 patients with the parallel pain-pressure relationship. Postsphincterotomy manometry showed disappearance of both the pressure elevation and pain induction, and the morphine-Prostigmin test turned negative. It is concluded that morphine-induced bile duct pressure elevation coinciding with pain is diagnostic of sphincter spasm as a cause of postcholecystectomy pain, the morphine-Prostigmin test, although helpful, is less specific and less sensitive in diagnosing sphincter spasm than the manometry, and endoscopic sphincterotomy relieves the pain due to this condition in most cases.
对17例胆囊切除术后疼痛患者和9例对照者进行了非手术胆道测压研究，通过吗啡刺激Oddi括约肌痉挛。尽管吗啡使胆管压力升高，但对照者仍无症状。13例胆囊切除术后疼痛患者中，吗啡诱发的疼痛与压力升高平行。另外3例患者的疼痛与压力变化不平行，还有1例患者压力升高但无疼痛。在传统的吗啡-新斯的明试验中，对照者、4例疼痛与压力变化平行者及1例疼痛与压力相关性不一致者均为阴性。内镜下括约肌切开术使12例疼痛与压力关系平行的患者的疼痛得到完全缓解（8例）、中度缓解（3例）或轻度缓解（1例）。括约肌切开术后测压显示压力升高和疼痛诱发均消失，吗啡-新斯的明试验转为阴性。结论是，吗啡诱发的胆管压力升高与疼痛同时出现可诊断为括约肌痉挛是胆囊切除术后疼痛的原因，吗啡-新斯的明试验虽然有帮助，但在诊断括约肌痉挛方面比测压特异性和敏感性更低，内镜下括约肌切开术在大多数情况下可缓解由此引起的疼痛。
