Wehrmann T, Wiemer K, Lembcke B, Caspary W F, Jung M
Department of Internal Medicine II, University Hospital, Frankfurt, Germany.
Eur J Gastroenterol Hepatol. 1996 Mar;8(3):251-6. doi: 10.1097/00042737-199603000-00012.
To assess the incidence of elevated sphincter of Oddi baseline pressure and the response to endoscopic sphincterotomy in patients with suspected sphincter of Oddi dysfunction.
A 5-year prospective clinical trial.
One-hundred and eight patients with recurrent biliary-type pain after cholecystectomy were enrolled. After thorough investigation, 35 patients with suspected type II sphincter of Oddi dysfunction (SOD) and another 29 type III patients remained for further investigation. Both groups were similar with respect to demographic data and severity of pain. Biliary manometry was performed in all except three patients in either group. Endoscopic sphincterotomy was performed in all patients with abnormal sphincter of Oddi baseline pressure (> 40 mmHg). All patients were clinically re-evaluated after 4-6 weeks, and thereafter the sphincterotomized patients were followed for a median period of 2.5 years.
An abnormal sphincter of Oddi baseline pressure was found in 62.5% of the type II patients and in 50% of the patients with suspected type III SOD (P = 0.66). At the 4-6 week follow-up none of those patients without abnormal manometry, but 70% of the patients with type II SOD, and 39% of the type III SOD patients, respectively, reported subjective benefit after sphincterotomy (P = 0.13 type II vs. type III). However, after a median follow-up of 2.5 years, sustained symptomatic improvement after sphincterotomy was found in 60% of the type II patients, but only in 8% of the patients with type III SOD (P < 0.01).
Disregarding a lack of difference in the incidence of abnormal sphincter of Oddi baseline pressure between type II and type III SOD, the Geenen-Hogan classification helps to predict the clinical outcome after endoscopic sphincterotomy.
评估疑似Oddi括约肌功能障碍患者Oddi括约肌基础压力升高的发生率以及内镜下括约肌切开术的疗效。
一项为期5年的前瞻性临床试验。
纳入108例胆囊切除术后复发性胆绞痛型疼痛患者。经过全面检查，35例疑似II型Oddi括约肌功能障碍（SOD）患者和另外29例III型患者继续接受进一步检查。两组在人口统计学数据和疼痛严重程度方面相似。除两组各有3例患者外，其余患者均进行了胆道测压。对所有Oddi括约肌基础压力异常（>40 mmHg）的患者进行内镜下括约肌切开术。所有患者在4 - 6周后进行临床重新评估，此后对接受括约肌切开术的患者进行了为期2.5年的中位随访。
62.5%的II型患者和50%的疑似III型SOD患者发现Oddi括约肌基础压力异常（P = 0.66）。在4 - 6周的随访中，测压正常的患者均无主观改善，但II型SOD患者中有70%、III型SOD患者中有39%在括约肌切开术后报告有主观改善（II型与III型比较，P = 0.13）。然而，在中位随访2.5年后，II型患者中有60%括约肌切开术后症状持续改善，但III型SOD患者中只有8%（P < 0.01）。
尽管II型和III型SOD患者Oddi括约肌基础压力异常发生率无差异，但Geenen - Hogan分类有助于预测内镜下括约肌切开术后的临床结局。
