Wehrmann T, Wendler O G, Jung M, Caspary W F
Medizinische Klinik II, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main.
Dtsch Med Wochenschr. 1997 Jun 20;122(25-26):808-14. doi: 10.1055/s-2008-1047693.
An increased incidence of pancreatitis having been reported after endoscopic manometry (EM) of the sphincter of Oddi, its incidence and severity as well as potential risk factors were investigated prospectively.
Between June 1988 and June 1996, standardised manometry was performed in 207 patients with suspected biliary and 23 with suspected pancreatic sphincter of Oddi dysfunction (SOD). All patients had been observed in hospital for at least 24 hours before the test. The diagnostic criteria of post-manometric pancreatitis (PMP) were epigastric pain and a rise in the concentration of serum amylase to at least three times normal. Potential risk factors for PMP were elucidated by uni- and multivariate analysis.
Pancreatitis occurred in 19 patients (9%) with suspected biliary and in 6 (26%) with suspected pancreatic SOD (P < 0.01), 17 of mild and 8 of moderate degree. There were no deaths and no lasting sequelae. Previous pancreatitis after endoscopic retrograde cholangiopancreatography and the presence of SOD were identified as patient-associated risk factors (P < 0.01 for each). Method-associated risk factors were duration of manometry of more than 5 min (P < 0.05) and manometry in the pancreatic duct system (P < 0.05). The risk of pancreatitis was reduced by simultaneous endoscopic sphincterotomy for SOD (P < 0.01).
Specific and often avoidable risk factors for postmanometric pancreatitis were identified: technical procedure, pancreatitis, SOD. With short duration of manometry, avoiding of manometry in the pancreatic duct system and with patient's informed consent for simultaneous endoscopic sphincterotomy risk of pancreatitis may be lowered.
鉴于有报道称内镜下Oddi括约肌测压（EM）后胰腺炎发病率增加，故对其发病率、严重程度及潜在危险因素进行前瞻性研究。
1988年6月至1996年6月期间，对207例疑似胆道Oddi括约肌功能障碍（SOD）患者和23例疑似胰腺SOD患者进行了标准化测压。所有患者在检查前均已住院观察至少24小时。测压后胰腺炎（PMP）的诊断标准为上腹部疼痛且血清淀粉酶浓度升高至至少正常水平的三倍。通过单因素和多因素分析阐明PMP的潜在危险因素。
19例（9%）疑似胆道SOD患者和6例（26%）疑似胰腺SOD患者发生胰腺炎（P<0.01），其中17例为轻度，8例为中度。无死亡病例，也无持久后遗症。内镜逆行胰胆管造影术后既往有胰腺炎病史以及存在SOD被确定为与患者相关的危险因素（各P<0.01）。与方法相关的危险因素为测压持续时间超过5分钟（P<0.05）以及在胰管系统内进行测压（P<0.05）。对于SOD患者，同时进行内镜括约肌切开术可降低胰腺炎风险（P<0.01）。
确定了测压后胰腺炎的特定且通常可避免的危险因素：技术操作、胰腺炎、SOD。通过缩短测压持续时间、避免在胰管系统内进行测压以及在患者知情同意的情况下同时进行内镜括约肌切开术，可降低胰腺炎风险。
