十二指肠乳头旁憩室对内镜十二指肠乳头切开术治疗胆总管结石及其并发症的影响

Effects of Juxtapapillary Duodenal Diverticulu on Endoscopic Sphincterotomy in Treating Common Bile Duct Stone and Its Complications

目的探讨十二指肠乳头旁憩室(juxtapapillary duodenal diverticulum,JPDD)与胆总管结石的关系,以及对内镜乳头括约肌切开术(EST)治疗胆总管结石和术后并发症的影响。方法回顾性分析513例ERCP病例,其中行EST治疗胆总管结石253例,合并JPDD的胆总管结石51例。分析JPDD与胆总管结石发生的关系;比较合并JPDD胆总管结石组与未合并JPDD胆总管结石组ERCP插管成功率、EST胆总管取石成功率及其并发症发生率的差异。结果 JPDD组原发性胆总管结石发生率显著高于无JPDD组(18.4%VS 8.9%,P<0.01)。与未合并JPDD胆总管结石组比较,合并JPDD胆总管结石组ERCP插管成功率无显著性差异(96.1%VS 99.5%,P>0.05),而EST取石成功率明显降低(91.8%VS 99.5%,P<0.05),EST术后创口出血显著增多(11.1%VS 1.9%,P<0.01),其他近期并发症及远期并发症发生率均无显著性差异(P>0.05)。结论 JPDD与原发性胆总管结石的发生相关;JPDD对EST治疗胆总管结石有一定影响;EST仍是治疗合并JPDD胆总管结石的一种相对安全、有效的治疗手段。

Abstract： Objective To investigate the relationship between juxtapapillary duodenal diverticulu（JPDD） and choledo- choiithiasis and the effects of JPDD on endoscopic spbincterotomy（EST） in treating choledocholithiasis and its complications. Methods 513 ERCP cases were retrospectively analyzed,which included 253 EST cases in treating eholedocholithiasis,51 ca- ses of common bile duct stones combined with JPDD. The relationship between JPDD and choledocholithiasis were probed. The differences on the success rate of ERCP , the success rate of the stone removal by EST, and the complications caused by EST between the eholedocholithiasis groups with and without JPDD were compared. Results The incidence of primarily common bile duct stones in the group with JPDD was significantly higher than that of the group without JPDD. Compared with the chole- docholithiasis without JPDD group, the success rate of the stone removal by EST was significantly decreased and the incidence of wound bleeding of EST was significantly increased in the choledocholithiasisgroup with JPDD（ P 〈 0. O1 ） ,while the success rate of ERCP,the incidence of the other short-term complications and long-term complicatrions after EST in the eholedocholithiasis group with JPDD showed no obvious statistical difference （P 〉 0. 05 ）. Conclusion JPDD is relative with primarily common bile duct stones. JPDD makes EST a little more difficult and risky, while EST is still a safe and effective therapy for choledocho- lithiasis patients combined with JPD .