Wehrmann T, Wiemer K, Lembcke B, Jung M
Department of Internal Medicine II, J. W. Goethe University Hospital, Frankfurt.
Z Gastroenterol. 1995 Nov;33(11):662-8.
Patients with fibrotic papillary stenosis (PS) are at high risk for sphincter of Oddi-re-stenosis after endoscopic sphincterotomy (ES). Therefore, a prospective trial was conducted to assess the acute and long-term effects of ES on sphincter of Oddi motor function in patients with papillary stenosis. The immediate effects of ES were studies by endoscopic manometry in 12 patients with PS, and in 15 patients with common bile duct stones (CBDS, control group). Furthermore, after a median follow-up of 15 months, 11 from those 12 patients with papillary stenosis were reinvestigated with ERCP and manometry. Complete ES (defined by a common bile duct pressure and a basal sphincter of Oddi-pressure (BSOP) < 5 mm Hg) was achieved in 13/15 CBDS-patients, but only in 3/12 patients with PS (p<0.01), although sphincterotomy was extended to the maximal length as judged endoscopically. Four patients with PS had a residual BSOP > 20 mm Hg. However, all patients with PS became symptom-free immediately after ES. The phasic sphincter motility was not affected significantly different in both groups of patients (p = 0.25). Those patients with a residual BSOP > 20 mm Hg after ES developed sphincter of Oddi-re-stenosis during the follow-up (3 patients) or revealed re-stenosis at the control examination after follow-up (1 patient). After the follow-up manometrically defined complete sphincterotomy was furtheron demonstrable in only 2/11 patients with papillary stenosis. In conclusion, ES revealed a decreased efficacy to eliminate the sphincter of Oddi motor function in a substantial number of patients with papillary stenosis. This may explain the remarkably high rate of sphincter of Oddi-re-stenosis after sphincterotomy in these patients.
纤维化乳头狭窄（PS）患者在内镜下括约肌切开术（ES）后发生Oddi括约肌再狭窄的风险很高。因此，进行了一项前瞻性试验，以评估ES对乳头狭窄患者Oddi括约肌运动功能的急性和长期影响。通过内镜测压研究了12例PS患者和15例胆总管结石患者（CBDS，对照组）ES的即时效果。此外，在中位随访15个月后，对12例乳头狭窄患者中的11例进行了ERCP和测压复查。13/15例CBDS患者实现了完全ES（定义为胆总管压力和Oddi括约肌基础压力（BSOP）<5 mmHg），但仅3/12例PS患者实现了完全ES（p<0.01），尽管在内镜判断下括约肌切开术已延长至最大长度。4例PS患者的残余BSOP>20 mmHg。然而，所有PS患者在ES后立即症状消失。两组患者的阶段性括约肌运动未受到显著不同的影响（p = 0.25）。ES后残余BSOP>20 mmHg的患者在随访期间发生Oddi括约肌再狭窄（3例）或在随访后的对照检查中显示再狭窄（1例）。随访后，仅2/11例乳头狭窄患者通过测压确定仍可证明完全括约肌切开术。总之，ES在大量乳头狭窄患者中显示出消除Oddi括约肌运动功能的疗效降低。这可能解释了这些患者括约肌切开术后Oddi括约肌再狭窄率极高的原因。
