十二指肠憩室的诊断与治疗

Diagnosis and management of duodenal diverticulum

目的探讨十二指肠憩室的临床表现,诊断和治疗。方法回顾性分析2年7个月期间收治的105例患者的临床资料。结果全组患者症状以腹痛多见(54例),其次是以返酸、恶心、呕吐等症状(21例),主要经消化道造影检查和内镜检查诊断。68例行保守治疗,其中1例出现病情反复,行憩室旷置术(胃大部切除、胃肠吻合术,Billroth II)。37例经外科治疗,其中22例因合并胆道系统疾病行相关手术;11例反复发作憇室炎行憇室旷置手术(5例)或切除手术(6例);4例行其他手术。105例均随访1年,未见明显不适。结论十二指肠憩室的症状以腹痛为主,多经消化内镜和消化道造影诊断,多数可以保守治疗,外科治疗需严格掌握手术适应证。

Objective To investigate the manifestations,diagnosis and management of duodenal diverticulum. Methods The clinical data of 105 patients with duodenal diverticulum admitted to our hospital during two years and seven months were retrospectively analyzed. Results Of the patients,the most common symptom was abdominal pain（54 cases）,followed by the symptoms of sour regurgitation,nausea and vomiting（21 cases）.The patients were diagnosed mainly by endoscopic and radiographic examination of gastrointestinal tract.Sixty-eight patients received conservative treatment,one of whom underwent duodenal diverticulization operation（Billroth II gastrectomy and gastrojejunostomy） later due to repeated recurrence of symptoms.The other 37 cases received surgical treatment,of which,22 cases complicated by biliary tract diseases underwent related operations,and 11 cases underwent duodenal diverticulization（5 cases） or diverticulectomy（6 cases） due to recurrent diverticulitis,and 4 cases underwent other procedures.No obvious discomfort was found in all the 105 patients during one year of follow-up. Conclusions The most common symptom of duodenal diverticulum is abdominal pain,and duodenal diverticulum is discovered mainly by endoscopic and radiographic examination of gastrointestinal tract.Conservative management is suitable for the majority of duodenal diverticula,and the indications for surgery should be strictly controlled.