Gallbladder and Sphincter of Oddi Disorders
Gallbladder and Sphincter of Oddi Disorders
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DOI：
10.1053/j.gastro.2016.02.033
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发表时间：
2016-05-01
期刊：
影响因子：
29.4
通讯作者：
Corazziari, Enrico S.
中科院分区：
文献类型：
--
作者：
Cotton, Peter B.;Elta, Grace H.;Corazziari, Enrico S.
胆囊、胆囊管和奥狄氏括约肌的运动障碍可引起疼痛综合征的概念很有吸引力，至少在美国是流行的。然而，通常进行的消融治疗（如胆囊切除术和括约肌切开术）的结果并不一致。常用于诊断功能障碍的检查（如动态胆囊造影和括约肌测压）的预测价值存在争议。这些患者的评估和管理是困难的波动症状和侵入性干预的安慰剂效应。最近一项严格的研究表明，对于胆囊切除术后疼痛且检查时很少或没有客观异常的患者，括约肌切开术并不比假治疗好，因此，奥狄括约肌功能障碍III型的旧概念被抛弃。内窥镜逆行胰胆管造影方法不再适用于这种情况。迫切需要类似的前瞻性研究，为临床医生处理这些患者提供更好的指导。我们需要明确功能性胆囊疾病患者胆囊切除术的适应症，以及括约肌功能障碍与有胆道梗阻证据的患者（以前的Oddi括约肌功能障碍II型，现在称为“功能性胆道括约肌障碍”）和特发性急性复发性胰腺炎的相关性。
The concept that motor disorders of the gallbladder, cystic duct, and sphincter of Oddi can cause painful syndromes is attractive and popular, at least in the United States. However, the results of commonly performed ablative treatments (eg, cholecystectomy and sphincterotomy) are not uniformly good. The predictive value of tests that are often used to diagnose dysfunction (eg, dynamic gallbladder scintigraphy and sphincter manometry) is controversial. Evaluation and management of these patients is made difficult by the fluctuating symptoms and the placebo effect of invasive interventions. A recent stringent study has shown that sphincterotomy is no better than sham treatment in patients with post-cholecystectomy pain and little or no objective abnormalities on investigation, so that the old concept of sphincter of Oddi dysfunction type III is discarded. Endoscopic retrograde cholangiopancreatography approaches are no longer appropriate in that context. There is a pressing need for similar prospective studies to provide better guidance for clinicians dealing with these patients. We need to clarify the indications for cholecystectomy in patients with functional gallbladder disorder and the relevance of sphincter dysfunction in patients with some evidence for biliary obstruction (previously sphincter of Oddi dysfunction type II, now called "functional biliary sphincter disorder") and with idiopathic acute recurrent pancreatitis.