壶腹周围憩室与内镜后复发性胆管结石的关系

Relationship between periampullary diverticulum and recurrent bile duct stones after endoscopic surgery

目的:探讨壶腹周围憩室与内镜后复发性胆管结石的关系.方法:选择1998-06/2002-01因胆管结石(此前均行腹腔镜胆囊切除)行十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)的患者1236例,将其中内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)确诊的185例壶腹周围憩室患者根据临床分型分为乳头旁型(n=96)和胆胰管直接开口于憩室型(n=89),随机抽取95例无憩室患者设为对照组,通过8年后随访比较胆管结石复发情况.结果:十二指肠乳头旁憩室组8年胆管结石复发率26.32%,直接开口于憩室组是34.83%,对照组是9.47%,经卡方检验乳头旁憩室组与对照组差异显著(χ2=8.78,P<0.05),直接开口于憩室组与对照组差异显著(χ2=17.15,P<0.05),而乳头旁憩室组与直接开口组无统计学意义(χ2=1.71,P>0.05).结论:壶腹周围憩室与内镜后胆管结石的复发关系密切,而于憩室的位置无明显关系,壶腹周围憩室可能是复发性胆管结石的一个重要风险因素.

AIM：To study the relationship between periampullary diverticulum and recurrent bile duct stones after endoscopic surgery.METHODS：One hundred and eighty-five patients with periampullary diverticula were divided into two groups：96 with peripapillary diverticula and 89 with direct opening of biliary duct into the diverticula.Ninety-five patients with non-diverticular disease were used as controls.After 8 years of follow-up,the recurrence rates of bile duct stones were compared among the three groups of patients.RESULTS：The recurrence rates of bile duct stones at 8 years after endoscopic surgery were 26.32% in patients with periampullary diverticula,34.83% in patients with direct opening of biliary duct into the diverticula,and 9.47% in controls.Significant differences were noted in the recurrence rates of bile duct stones between controls and the two groups of patients with periampullary diverticula （χ2=8.78,17.15,P 0.05） though there was no statistical difference between the latter two groups （χ2=1.71,P 0.05）.CONCLUSION：Periampullary diverticula is closely related to the recurrence of bile duct stones after endoscopic surgery.There is no obvious relationship between the location of diverticula and the recurrence of bile duct stones.Periampullary diverticulum may be an important risk factor for recurrent bile duct stones.