Bozkurt T, Orth K H, Butsch B, Lux G
Department of Internal Medicine and Gastroenterology, Community and Academic Teaching Hospital, University of Cologne, Solingen, Germany.
Eur J Gastroenterol Hepatol. 1996 Mar;8(3):245-9. doi: 10.1097/00042737-199603000-00011.
The purpose of the present study was to investigate prospectively the value of manometry, non-invasive techniques and endoscopic sphincterotomy in biliary type II and III patients with suspected sphincter of Oddi dysfunction.
All patients (n = 31) had undergone a cholecystectomy from 1 to 45 years before entry into the study, and had a history of biliary-type pain ranging from 4 to 156 months. In a primary diagnostic work-up, including ERCP, other causes of gastrointestinal disease were excluded. The width of the common bile duct, pain induced by the injection of contrast medium into the common bile duct, delayed contrast drainage and the results of a morphine-neostigmine test were analysed. Manometric measurements of basal sphincter of Oddi pressure were performed. Twenty-three patients with an elevated basal pressure (> 40 mmHg) underwent endoscopic sphincterotomy.
During the follow-up period (8-62 months) 83% of the patients became symptom free or experienced an improvement. Basal sphincter of Oddi pressure and long-term clinical outcome of patients correlated to different degrees with the results of non-invasive techniques.
Our data suggest that endoscopic sphincterotomy may be an effective therapeutic modality in group II and III patients with sphincter of Oddi dysfunction in whom other gastrointestinal disorders have previously been excluded.
本研究旨在前瞻性地探讨测压法、非侵入性技术及内镜括约肌切开术在疑似Oddi括约肌功能障碍的II型和III型胆管疾病患者中的价值。
所有患者（n = 31）在进入本研究前1至45年已接受胆囊切除术，且有4至156个月的胆源性疼痛病史。在包括内镜逆行胰胆管造影（ERCP）在内的初步诊断检查中，排除了其他胃肠道疾病病因。分析胆总管宽度、向胆总管内注射造影剂诱发的疼痛、造影剂延迟引流情况以及吗啡 - 新斯的明试验结果。对Oddi括约肌基础压力进行测压测量。23例基础压力升高（> 40 mmHg）的患者接受了内镜括约肌切开术。
在随访期（8 - 62个月）内，83%的患者症状消失或有所改善。Oddi括约肌基础压力和患者的长期临床结局与非侵入性技术的结果存在不同程度的相关性。
我们的数据表明，对于先前已排除其他胃肠道疾病的II型和III型Oddi括约肌功能障碍患者，内镜括约肌切开术可能是一种有效的治疗方式。
