Functional gallbladder and sphincter of Oddi disorders
Functional gallbladder and sphincter of Oddi disorders
复制标题
DOI：
10.1053/j.gastro.2005.11.063
复制
发表时间：
2006-04-01
期刊：
影响因子：
29.4
通讯作者：
Toouli, James
中科院分区：
文献类型：
--
作者：
Behar, Jose;Corazziari, Enrico;Toouli, James
胆囊性功能障碍(GB)是一种最初由代谢异常或原发动力改变引起的运动障碍。Oddi括约肌(SO)的功能障碍包括胆管或胰腺SO的运动异常。1313和/或Billary的功能障碍会产生类似的疼痛模式。胰腺功能障碍引起的疼痛可能类似于急性胰腺炎。胆管运动功能障碍的症状诊断标准是位于上腹部和右上腹部持续至少30分钟的中度至重度持续性疼痛发作。在排除胆结石和其他结构异常后，怀疑有GB运动障碍。这一诊断应通过在胆道核素扫描时由缩胆素引起的GB射血分数降低以及在胆囊切除术后反复胆道疼痛消失后得到确认。胆道SO功能障碍的症状可能伴随有一过性胆道梗阻的特征，而胰腺SO功能障碍的症状与胰酶升高甚至胰腺炎有关。胆汁型SO功能障碍更常见于胆囊切除术后的患者。因此，测压对于选择括约肌功能障碍的患者是有价值的；然而，由于并发症的发生率很高，这些患者应该转诊到专家单位进行这样的评估。因此，只有在有令人信服的临床证据和非侵入性检测结果为阴性的情况下，才能进行侵入性检测。委员会建议，只有当患者有严重症状，符合所需标准，并排除其他诊断时，才考虑胆管或胰腺括约肌的分离。
The functional disorder of the gallbladder (GB) is a motility disorder caused initially either by metabolic abnormalities or by a primary motility alteration. The functional disorders of the sphincter of Oddi (SO) encompass motor abnormalities of either the biliary or the pancreatic SO. Dysfunction of the 1313 and/or billary SO produce similar patterns of pain. The pain caused by a dysfunction of the pancreatic SO can be similar to that of acute pancreatitis. The symptom-based diagnostic criteria of motility dysfunction of the GB and biliary SO are episodes of moderate to severe steady pain located in the epigastrium and right upper abdominal quadrant that last at least 30 minutes. GB motility disorder is suspected after gallstones and other structural abnormalities have been excluded. This diagnosis should then be confirmed by a decreased GB ejection fraction induced by cholecystokinin at cholescintigraphy and after disappearance of the recurrent biliary pain after cholecystectomy. Symptoms of biliary SO dysfunction may be accompanied by features of transient biliary obstruction, and those of pancreatic SO dysfunction are associated with elevation of pancreatic enzymes and even pancreatitis. Biliary-type SO dysfunction is more frequently recognized in postcholecystectomy patients. SO manometry is valuable to select patients with sphincter dysfunction; however, because of the high incidence of complications, these patients should be referred to an expert unit for such assessment. Thus invasive tests should be performed only in the presence of compelling clinical evidence and after noninvasive testing has yielded negative findings. The committee recommends that division of the biliary or pancreatic sphincters only be considered when the patient has severe symptoms, meets the required criteria, and other diagnoses are excluded.