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首页> 外文期刊>Surgical Endoscopy >Botulinum toxin-induced relaxation of the sphincter of Oddi may select patients with acalculous biliary pain who will benefit from cholecystectomy.
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Botulinum toxin-induced relaxation of the sphincter of Oddi may select patients with acalculous biliary pain who will benefit from cholecystectomy.

机译：肉毒杆菌毒素诱导的Oddi括约肌松弛可能会选择胆管钙化性疼痛的患者，这些患者将从胆囊切除术中受益。

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BACKGROUND: Acalculous biliary pain may be due to gallbladder dyskinesia or sphincter of Oddi (SO) hypertension. These two etiologies are difficult to differentiate because the gallbladder ejection fraction may be low and the SO manometry results may be abnormal in both. Cholecystectomy is advised for patients with biliary dyskinesia, but it often exacerbates biliary pain for patients with SO hypertension. The biliary pain response to relaxation of the SO using botulinum toxin may indicate appropriate treatment for patients with acalculous biliary pain. METHODS: The protocol-based management of 25 patients with acalculous biliary pain and two gallbladder ejection fraction estimations less than 40% who had 100 units of botulinum toxin injected into their SO musculature to relax the sphincter has been audited. Patients whose pain was temporarily relieved after botulinum toxin injection were offered endoscopic biliary sphincterotomy, and patients who failed to experience benefit after botulinum toxin injection were assessed for laparoscopic cholecystectomy. RESULTS: Botulinum toxin was injected into the SO of 25 patients, with 11 experiencing temporary biliary pain relief. Of these patients, 10 consented to undergo endoscopic biliary sphincterotomy, with relief of biliary pain in all cases. A total of 14 patients had a negative response to botulinum toxin treatment, with 10 of these patients progressing to laparoscopic cholecystectomy, which resulted in biliary pain relief in eight cases. CONCLUSION: Botulinum toxin-induced relaxation of the SO may help to direct appropriate therapy for patients with acalculous biliary pain. The data from this study supports the establishment of a randomized clinical trial.
机译：背景：胆道无力性疼痛可能是由于胆囊运动障碍或Oddi（SO）高血压括约肌引起的。这两种病因难以区分，因为两者的胆囊射血分数可能较低，SO测压结果可能异常。胆囊运动障碍的患者建议进行胆囊切除术，但SO高血压患者通常会加重胆道疼痛。使用肉毒杆菌毒素对SO舒张引起的胆道疼痛反应可能表明对钙化性胆道疼痛患者的适当治疗。方法：已对25例胆道钙化性疼痛和两次胆囊射血分数估计不足40％的患者进行了基于协议的管理，这些患者将100单位肉毒杆菌毒素注入其SO肌肉中以放松括约肌。肉毒杆菌毒素注射后疼痛暂时缓解的患者接受内镜下胆囊括约肌切开术，肉毒杆菌毒素注射后未能受益的患者接受腹腔镜胆囊切除术评估。结果：25例患者的SO中注射了肉毒杆菌毒素，其中11例暂时性胆道疼痛缓解。在这些患者中，有10例同意接受内镜下胆囊括约肌切开术，在所有情况下均减轻了胆道疼痛。共有14例患者对肉毒杆菌毒素治疗产生了阴性反应，其中10例患者进行了腹腔镜胆囊切除术，从而使8例患者的胆道疼痛得到缓解。结论：肉毒杆菌毒素引起的SO舒张可能有助于指导胆道钙化性疼痛患者的适当治疗。这项研究的数据支持建立随机临床试验。

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