内镜下十二指肠乳头括约肌切开术联合球囊扩张术治疗不同类型十二指肠乳头旁憩室合并胆总管结石的效果分析

Effect Analysis of Endoscopic Sphincterotomy Combined with Endoscopic Papillary Balloon Dilation in Treatment of Different Types of Juxtapapillary Duodenal Diverticula with Choledocholithiasis

目的:分析内镜下十二指肠乳头括约肌切开术联合球囊扩张术治疗不同类型十二指肠乳头旁憩室合并胆总管结石的效果。方法:回顾性选取2017年1月—2022年6月威海市中心医院收治的十二指肠乳头旁憩室合并胆总管结石患者103例作为研究对象,依据十二指肠乳头旁憩室与十二指肠乳头相对位置分为包绕型组(n=8)、边缘型组(n=43)、周围型组(n=52)。所有患者行内镜下十二指肠乳头括约肌切开术联合球囊扩张术取石。比较三组手术指标及并发症发生情况。结果:三组取石操作时间比较,包绕型组>边缘型组>周围型组,差异有统计学意义(P<0.05);三组一次性取石成功率、机械碎石使用率比较,差异无统计学意义(P>0.05)。三组急性胰腺炎发生率比较,包绕型组>边缘型组>周围型组,差异有统计学意义(P<0.05);三组高淀粉酶血症、胆道感染、出血、穿孔发生率比较,差异无统计学意义(P>0.05)。结论:内镜下十二指肠乳头括约肌切开术联合球囊扩张术治疗包绕型十二指肠乳头旁憩室合并胆总管结石的取石操作时间较边缘型、周围型患者长,且患者术后急性胰腺炎发生率高,需引起临床医师重视。

Objective:To analyze the effect of endoscopic sphincterotomy combined with endoscopic papillary balloon dilation in treatment of different types of juxtapapillary duodenal diverticula with choledocholithiasis.Methods:A total of 107 patients with juxtapapillary duodenal diverticula and choledocholithiasis who were admitted to Weihai Central Hospital from January 2017 to June 2022 were selected retrospectively as the study subjects.According to the relative position of juxtapapillary duodenal diverticula to the duodenal papilla,the patients were divided into encircling type group(n=8),marginal type group(n=43)and peripheral type group(n=52).All patients underwent endoscopic sphincterotomy combined with endoscopic papillary balloon dilation for stone removal.The operation indexes and complications of the three groups were compared.Results:The operation time of stone removal was ranked as follows:encircling type group>marginal type group>peripheral type group,and there was a statistically significant difference among the three groups(P<0.05).There was no significant difference in the success rate of one-time stone removal and the utilization rate of mechanical lithotripsy among the three groups(P>0.05).The incidence of acute pancreatitis was ranked as follows:encircling type group>marginal type group>peripheral type group,and there was a statistically significant difference among the three groups(P<0.05).There was no significant difference in the incidences of hyperamylaseemia,biliary tract infection,bleeding and perforation among the three groups(P>0.05).Conclusion:Endoscopic sphincterotomy combined with endoscopic papillary balloon dilation in treatment of encircling juxtapapillary duodenal diverticula with choledocholithiasis has a longer operation time of stone removal than that in treatment of marginal type and peripheral type,and the incidence of postoperative acute pancreatitis is high,which should be paid attention to by clinicians.