Sugiyama M, Atomi Y
First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Gut. 1996 Dec;39(6):856-9. doi: 10.1136/gut.39.6.856.
Some of patients with an intact gall bladder develop acute cholecystitis or have gall bladder stone formation after endoscopic sphincterotomy. Endoscopic sphincterotomy may affect gall bladder motility.
To prospectively evaluate longterm effect of endoscopic sphincterotomy on gall bladder motility.
Thirty two patients with an intact gall bladder (15 with and 17 without gall bladder stones) who underwent endoscopic sphincterotomy for choledocholithiasis.
Gall bladder function was examined before and at from seven days to five years after sphincterotomy. Gall bladder volume, at fasting and after caerulein administration, was determined by ultrasonography.
After endoscopic sphincterotomy, the enlarged orifice remained patent during a five year follow up period. One patient with gall bladder stones subsequently developed acute cholecystitis, the remaining being asymptomatic. In the patients before sphincterotomy, particularly in those with gall bladder stones, the gall bladder showed larger fasting volume and lower caerulein stimulated maximum contraction than normal controls. Throughout five years after sphincterotomy, fasting volume of the gall bladder decreased and its maximum contraction increased, regardless of gall bladder stones; significantly different from the values before sphincterotomy (p < 0.05).
Endoscopic sphincterotomy decreases fasting volume of the gall bladder and increases its contraction ability for a long period. These changes may rather decrease the risk of future acute cholecystitis or gall stone formation.
部分胆囊完整的患者在接受内镜括约肌切开术后会发生急性胆囊炎或形成胆囊结石。内镜括约肌切开术可能会影响胆囊的运动功能。
前瞻性评估内镜括约肌切开术对胆囊运动功能的长期影响。
32例胆囊完整的患者（15例有胆囊结石，17例无胆囊结石），因胆总管结石接受了内镜括约肌切开术。
在括约肌切开术前及术后7天至5年期间检查胆囊功能。通过超声检查测定空腹及注射胆囊收缩素后的胆囊体积。
内镜括约肌切开术后，扩大的开口在5年随访期内保持通畅。1例有胆囊结石的患者随后发生了急性胆囊炎，其余患者均无症状。在括约肌切开术前，尤其是有胆囊结石的患者，胆囊的空腹体积较大，胆囊收缩素刺激后的最大收缩幅度低于正常对照组。在括约肌切开术后的5年中，无论有无胆囊结石，胆囊的空腹体积均减小，最大收缩幅度增加，与括约肌切开术前的值有显著差异（p < 0.05）。
内镜括约肌切开术可长期降低胆囊的空腹体积并增强其收缩能力。这些变化可能会降低未来发生急性胆囊炎或胆囊结石形成的风险。
