92例十二指肠乳头旁憩室与胆结石的关系

Relationship between periampullary diverticula and biliary calculi （anlysis of 92 cases）

目的：探讨十二指肠憩室在胆结石发病中的作用.方法：回顾性分析广东省东莞市人民医院和中山大学附属第二医院行逆行胰胆管造影检查的462例患者,其中合并乳头憩室92例（憩室组）.无合并乳头憩室370例（非憩室组）.分析比较两组患者年龄、胆结石的患病率、结石发生部位及结石成分方面的差异.结果：本组462例患者中,憩室组92例,占19.9%,非憩室组370例,占80.1%.憩室组平均年龄61.8岁,明显高于非憩室组（61.8 vs 51.2岁,P＜0.01）,且憩室发生率随年龄的增大而增高（P＜0.01）.本组92例十二指肠憩室有72例合并胆结石,其发生率78.26%,而非憩室组370例中仅97例合并胆结石,占26.2%.十二指肠憩室组并结石的发生率明显高于非憩室组.本组中乳头旁憩室胆结石发生率明显高于乳头周围型憩室者,有显著性差异.乳头旁憩室患者的原发性胆总管结石发生率明显高于继发性胆总管结石及胆囊结石,且结石成分主要为胆色素结石.结论：十二指肠乳头旁憩室患者胆结石发病率显著增高,且主要与原发性胆总管结石相关.

Objective：To investigate the role of pedampullary diverticula in the formation of biliary calculi. Methods：462 consecutive patients undergoing endoscopic retrograde cholangiopancreatography （ERCP） were prospectively enrolled. The patients were divided into two groups according to periampullary diverticula formation. The age and the frequencies of bile duct gallstones were compared between two groups. The site of the stones, their gross morphology and composition were analyzed. Results ： Periampullary diverticula （PAD） were found in 92 of 462 cases （ 19.9% ）. The average age of the ipatients with PAD was 61.8 years, which was significantly higher than that without PAD （61.8 vs 51.2 years, P 〈 0.01 ） and its incidence increased with age （ P 〈 0.01 ）. The biliary calculi were found 72 of 92 patients with PAD, and its incidence was 78.3% which was higher than those without PAD（97 of 370 cases ,26.2% ）. The incidence of primary bile duct stones in patients with PAD was significantly higher than that of secondary bile duct stones and gallbladder stones. Conclusion： Periampullary diverticula significantly increases the incidence of bile duct gallstones, and mainly primary bile duct stones.