Geenen J E, Toouli J, Hogan W J, Dodds W J, Stewart E T, Mavrelis P, Riedel D, Venu R
Gastroenterology. 1984 Oct;87(4):754-8.
Endoscopic sphincterotomy (ES) alters the structure and motor function of the sphincter of Oddi (SO). The magnitude and duration of these changes, however, have not been critically examined. Before ES, 22 patients with common bile duct stones were evaluated by endoscopic retrograde cholangiography. The pressure gradient between the common bile duct and the duodenum, the SO basal pressure, and the SO peak phasic pressures were obtained. After ES, the electrosurgical incision length was determined using the extended papillotome and an inflated Fogarty balloon as reference. A high correlation existed between the endoscopist's estimate of ES incision size using this technique and the actual length of simulated incisions fashioned in cardboard mounts. These studies were repeated in all 22 patients at 1-yr follow-up and in 8 of these patients at 2-yr follow-up. At 12 mo and 24 mo after ES, the common bile duct (CBD) to duodenal pressure gradient and the sphincter of Oddi basal pressure were virtually eliminated. The amplitude of SO phasic contractions was significantly diminished 12 mo after ES (124 +/- 16 mmHg to 37 +/- 10 mmHg; p less than 0.001), but 24 mo after ES, SO phasic contraction amplitude was not significantly different from the values before ES. Incision length at 1-yr follow-up was reduced in the group of 22 patients from 11.6 +/- 0.8 mm to 8.3 +/- 0.5 mm (p less than 0.001), and in the group of 8 patients from 11.0 +/- 1.5 mm to 7.5 +/- 0.7 mm (p less than 0.025). After an additional 12 mo, however, i.e., 24 mo after ES, the incision length was 6.5 +/- 0.7 mm. There was no significant difference in incision length between the 12-mo and 24-mo examinations. We conclude that after ES, incision length decreases during the first year. There appears to be no further significant reduction in incision length at 2 yr. In addition, the reduction of the CBD to duodenal pressure gradient and the SO basal pressure remain unchanged for at least 2 yr. These manometric findings support the observation that after ES the enlarged opening of the CBD into the duodenum remains open for at least 2 yr.
内镜括约肌切开术（ES）会改变奥迪括约肌（SO）的结构和运动功能。然而，这些变化的程度和持续时间尚未得到严格研究。在进行ES之前，对22例胆总管结石患者进行了内镜逆行胆管造影评估。测量了胆总管与十二指肠之间的压力梯度、SO基础压力以及SO相位峰值压力。ES术后，使用延长乳头切开刀和充气的Fogarty球囊作为参考来确定电外科切口长度。内镜医师使用该技术对ES切口大小的估计与在硬纸板模型上制作的模拟切口实际长度之间存在高度相关性。在所有22例患者的1年随访以及其中8例患者的2年随访中重复了这些研究。ES术后12个月和24个月时，胆总管（CBD）至十二指肠的压力梯度以及奥迪括约肌基础压力几乎消失。ES术后12个月时，SO相位收缩幅度显著减小（从124±16 mmHg降至37±10 mmHg；p＜0.001），但ES术后24个月时，SO相位收缩幅度与ES术前的值无显著差异。在22例患者组中，1年随访时切口长度从11.6±0.8 mm减少至8.3±0.5 mm（p＜0.001），在8例患者组中，从11.0±1.5 mm减少至7.5±0.7 mm（p＜0.025）。然而，再过12个月，即ES术后24个月时，切口长度为6.5±0.7 mm。12个月和24个月检查时的切口长度无显著差异。我们得出结论，ES术后，切口长度在第一年减少。2年时切口长度似乎没有进一步显著减少。此外，CBD至十二指肠压力梯度和SO基础压力的降低至少在2年内保持不变。这些测压结果支持了以下观察结果：ES术后，CBD向十二指肠的扩大开口至少在2年内保持开放。
