Ugljesić M, Bulajić M, Milosavljević T, Stimec B
Clinic for Gastroenterology and Hepatology, Institute for Digestive Diseases, Belgrade, Yugoslavia.
Hepatogastroenterology. 1995 Jul-Aug;42(4):348-51.
BACKGROUND/AIM: Endoscopic sphincterotomy (ES) of the sphincter of Oddi (SO) has been accepted as an effective method in extraction of common bile duct stones in postcholecystectomy patients. The purpose of this study was to examine the completeness of the performed ES and observe the post sphincterotomy pancreatic duct sphincter (PDS) activity using endoscopic manometry.
Activity of the sphincter of Oddi was examined in 15 sphincterotomized patients using endoscopic manometry one to 2.5 years after endoscopic sphincterotomy for choledocholithiasis.
In eight patients absence of choledochoduodenal gradient, baseline pressure and the sphincter of Oddi phasic activity up to 2.5 years after endoscopic sphincterotomy indicated a complete sphincterotomy. In seven patients with incomplete endoscopic sphincterotomy, manometry exhibited either a lower choledochoduodenal gradient and baseline pressure without phasic activity of the sphincter of Oddi (three patients), a sphincter of Oddi activity without choledochoduodenal gradient (one patient), or a complete restitution of the sphincter of Oddi activity 1 to 2 years after endoscopic sphincterotomy (three patients). In five patients, with complete endoscopic sphincterotomy, measurements of pancreatic sphincter activity showed lower values of the pancreatic ductal pressure and baseline pressure, while the pancreatic sphincter phasic activity was equal to that found in the control group.
Endoscopic manometry is method which enables us to test the completeness of endoscopic sphincterotomy and to follow the restitution of the phasic contractile function of the sphincter. Manometric findings reveal pancreatic sphincter in most patients as a separate sphincteric entity, the function of which is reduced but not eliminated by a complete endoscopic sphincterotomy.
背景/目的：在胆囊切除术后患者中，内镜下Oddi括约肌切开术（ES）已被公认为是一种有效取出胆总管结石的方法。本研究旨在通过内镜测压检查所施行的ES的完整性，并观察括约肌切开术后胰管括约肌（PDS）的活动情况。
对15例行内镜括约肌切开术治疗胆总管结石的患者，在内镜括约肌切开术后1至2.5年，使用内镜测压检查Oddi括约肌的活动情况。
8例患者在内镜括约肌切开术后长达2.5年，胆总管十二指肠压力差、基础压力及Oddi括约肌的阶段性活动消失，提示括约肌切开术完整。7例内镜括约肌切开术不完整的患者，测压显示要么胆总管十二指肠压力差和基础压力较低，且Oddi括约肌无阶段性活动（3例患者），要么Oddi括约肌有活动但无胆总管十二指肠压力差（1例患者），要么在内镜括约肌切开术后1至2年Oddi括约肌活动完全恢复（3例患者）。5例内镜括约肌切开术完整的患者，胰管括约肌活动的测量显示胰管压力和基础压力值较低，而胰管括约肌的阶段性活动与对照组相当。
内镜测压是一种能够检测内镜括约肌切开术完整性并跟踪括约肌阶段性收缩功能恢复情况的方法。测压结果显示，在大多数患者中，胰管括约肌是一个独立的括约肌结构，其功能在完全内镜括约肌切开术后虽有降低但并未消除。
