| PrefaceSphincter of Oddi ( SO) is very important in maintaining the normal bile duct pressure, promoting gallbladder to excrete and preventing from reflux, if it has Sphincter of Oddi Dysfuction (SOD) , the infection of bile duct and cholelithiasis will happen. Sphincter of Oddi Manometry ( SOM) is the golden standard to examine the SOD. Now it is common to measure the pressure of SO via Endo-scopic retrograde cholangiopancreatographic (ERCP) intubation directly. But it is now thought to be complicated by acute pancreatitis, if manometry is followed by ERCP, the incidence is more higher, may extend to 17%. Furthermore, it is complex to operate with ERCP, if with duodenal papillary malformation, it will cause into failure, and it could not be measured for long time. So it is limited in application. To choose a measurement simple operated and with little complications is very important. To measure via choledochofiberoscope is satisfied for this requirement. The pressure of SO is affected by many factors, such as neuronal hormonal and medical mechanism et al. Nitroester is thought to have the effect to relax SO, while opium analgesic drugs especially morphine could cause spasm of SO. Since morphine has this side effect, it is forbidden to biliary patients in clinics. But to some given patients, if they had severe pain and suffered by some diseases such as left heart failure and need morphine, the limit of administration was adverse obviously. So it was expectant for physicians to find some drugs that could antagonize the side effect of morphine to SO. In our study we will observe the effect of isosorbide dinitrate (ISDN ) and pentaerithrityl tetranitrate ( PTN ) in common dose on SOM with choledochofiberoscope.Patients and MethodsAll objects are the patients examined with choledochofiberscope in our hospital from Oct. 2003 to Mar. 2004. There were 47 patients selected. They all had undergone cholecystectomy, biliary exploring, T tube drainage, and were divided into 4 groups at random: isosorbide dinitrate (ISDN) solo group, pen-taerithrityl tetranitrate(PTN) solo group, Morphine Isosorbide Dinitrate association group, and Morphine pentaerithrityl tetranitrate association group. The apparatus selected were PC polygram HR and program, PENTEX electronic choledochofiberscope. Method: Inquiring disease history, diagnosis and the process of treatment, confirming the diagnosis. Keeping patients fast 8 hours before operation and without any drugs in last two days; Detecting with choledochofiberos-cope, observing SO figure and removing all the stones in common bile duct; Connecting pressure - measuring apparatus, inserting duct via side - pore of choledochofiberoscope and reaching duodenum directly, then drawing it slowly, measuring duodenal pressure ( DP) , basal pressure of sphincter of Oddi (SOBP) , contractive amplitude of sphincter of Oddi (SOCA) , contractive frequency of sphincter of Oddi (SOF) , contractive duration of sphincter of Oddi (SOCD) and the pressure of common bile duct (CBDP) respectively; completing the first measurement. Then the four groups were treated respectively: ISDN solo group, ISDN was administered sublingually in doses of 5mg after the first measurement, 10 minutes later, the second manometry was performed, and the third 20 minutes after administration; PTN solo group, all were the same as the group above but the drug was changed to PTN in dose of 20 mg; morphine and ISDN association group, morphine was administered by muscle injection in dose of lOmg after the first measurement, 10 minutes later, the second manometry was performed, and the procedure was repeated the third time after sublingual administration of ISDN in dose of 5mg for 10 minutes, thereafter 10 minutes the forth manometry was performed; morphine and PTN association group, all were the same as the group above but the drug was changed to PTN in dose,of 20mg. Recording and analyzing the pressure - curve with special program, final collec-ting the results.ResultsForty - seven patients with T - tube who had n...
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