十二指肠憩室内乳头的诊断和治疗

Diagnosis and treatment for the papilla of vater in the diverticula of duodenum

目的 总结十二指肠憩室内乳头的诊治经验。方法 回顾性分析 2 4例憩室内乳头的诊断和治疗 ,比较各术式的效果。结果 诊断以低张十二指肠造影 ,ERCP ,CT ,胆管造影为首选。治疗以未处理憩室的术式效果最差 ,死亡率 2 8 5 7% ,再手术率高达 5 7 14% ;单纯Oddi括约肌成形及胃肠或胆道的单改道手术简单 ,并发症低 ,但对伴有缩窄性乳头炎者效果差 ;憩室敞开加Oddi括约肌成形术 ,近期并发症高 ,但远期效果好。结论 低张十二指肠造影 ,ERCP ,胆管造影诊断率高。不合并缩窄性乳头炎的憩室内乳头 ,最适宜单行改道手术 ;合并缩窄性乳头炎的憩室内乳头者 ,应行憩室敞开加Oddi括约肌成形术。

Objective To summarize the experience in diagnosis and treatment for the papilla of Vater in diverticula of duodenum. Methods Diagnosis and treatment were retrospectively reviewed for 24 patients with papilla of Vater in diverticula. Effects of different procedures were compared. Results The first choice of diagnosis measures was hypotonicity duodenum barium meal photography, ERCP, CT and cholangiography. In treatment, the technique which the diverticula was untreated had the worst effect with a mortality rate of 28.57%, and reoperation rate as high as 57.14%. The simplicity oddi's sphincteroplasty and the turning of gastrointestinal juice or bile were simple with a low incidence of operative complications, but it showed worse effect for patients accompaned with constrictive papillitis. The long term effect of opening diverticula plus oddi's sphincteroplasty was excellent. Conclusions The hypotonicity duodenum barium meal photography, ERCP, CT and cholangiography have high diagnosis rate. In patients without constrictive papillitis, the effect of digastive tract or biliary duct bypass technique is good; In patients with constrictive papillitis, although the methods of openning the diverticula with sphincterplasty of oddi is complex, the best long term effect could be expected.