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Oddi括约肌功能障碍的治疗

Authors
Marc F Catalano, MD, FACG, FACP, FASGE, AGAF
Nirav C Thosani, MD, MHA
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
徐心, 副主任医师，副教授

引言

在胆总管末端和胰管末端穿过十二指肠壁时，将它们的汇合处环绕起来的肌肉结构便是Oddi括约肌(sphincter of Oddi, SO)(图 1)。术语“Oddi括约肌功能障碍(sphincter of Oddi dysfunction, SOD)”是指与SO机械性或功能性异常相关的胆道或胰腺梗阻临床综合征。乳头狭窄、硬化性乳头炎、胆道痉挛、胆道功能障碍和胆囊切除术后综合征都曾是SOD的同义词。

本文将总结SOD的治疗。该疾病的临床表现和诊断将单独讨论。 (参见“Oddi括约肌功能障碍的临床表现和诊断”)

自然病程

目前关于SOD远期自然病程的研究很少。现有数据显示，该病的临床病程在一定程度因初始的胆道问题分类而异。 (参见“Oddi括约肌功能障碍的临床表现和诊断”，关于‘分类系统’一节)

在一项为期1年的随访研究中，7例SO压力异常且接受假操作治疗的Ⅱ型患者(有胆道疼痛，以及肝功能检查异常或胆总管扩张)持续存在症状，实施括约肌切开术后才得以缓解。4年后，所有患者的一般情况依然良好。另有5例SO压力异常的Ⅱ型患者拒绝进行括约肌切开术。随访4年时，3例患者的症状无改善，而其他2例获得“适当”改善。

对于Ⅲ型胆道疼痛患者(胆道疼痛，但是肝功能检查及胆总管正常)，假治疗或进行内镜下括约肌切开后的临床病程不可预知。在一项报道中，有11例此类患者在括约肌切开术后接受了为期2年的随访，4例的症状获得改善，其他7例则没有变化。另有11例患者进行假治疗，在2年随访期间，5例的症状获得改善，其他6例则没有变化[1]。

               

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Literature review current through: 2017-06 . | This topic last updated: 2015-06-29.
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