十二指肠乳头旁憩室与胆管结石复发的关系

The relationship between juxtapapillary duodenal diverticulum and recurrence of biliary stones

目的 探讨十二指肠乳头旁憩室与胆管结石复发的关系.方法 回顾性分析2008年8月至2012年12月中南医院行内镜逆行胰胆管造影术的829例患者的完整临床资料,将其分为胆总管结石组（609例）、胆总管异常组（124例）、胆总管未见异常伴肝内胆管结石或胆囊结石组（38例）及对照组（58例）,其中十二指肠憩室者206例,无憩室者623例,分析十二指肠乳头旁憩室与胆管结石的形成与复发、术后胰腺炎及插管失败的关系.结果 胆总管结石组憩室发生率（27.8％）比胆总管异常组（18.5％）高（χ^2 =4.512,P＜0.05）.憩室者术后胰腺炎发病率（33.7％）较无憩室者（13.8％）高（χ^2=30.841,P＜0.05）.胆总管结石组伴有憩室者插管失败率（15.4％）高于无憩室者（6.8％）（χ^2=0.731,P＜0.05）.胆总管结石组术后复发率在伴有憩室者（19.5％）明显高于无憩室者（9.3％）（χ^2=14.51,P＜0.05）.结论 十二指肠憩室与结石形成、ERCP术后胰腺炎、插管失败、结石复发均有关.

Objective To explore whether the presence of juxtapapillary duodenal diverticula （JPDD） risks biliary stone disease and recurrence.Methods 829 patients undergoing ERCP in our hospital from Aug 2008 to Dec 2012 were divided into four groups：biliary stone disease （n =609） non-stone biliary abnormality （n =124） common bile duct malformation with cholelithiasis （n =38） and normal control group （n =58）.There were 206 patients with JPDD and 623 patients without JPDD.Biliary stoneformation,post-ERCP pancreatitis,cannulation failure,and stone recurrence were compared between those with JPDD and those without.Results The incidence of JPDD in biliary stone disease group （27.8%） was significantly higher than in non-stone biliary anatomical abnormality group （18.5 %） （χ^2 =4.512,P 〈 0.05）.In biliary stone disease group,rates of post-ERCP pancreatitis were significantly higher in JPDD cases （33.7%） compared to those without JPDD （13.8%） （χ^2 =30.841,P 〈 0.05）.The cannulation failure rate was also higher in patients with JPDD （15.4%） compared to JPDD negative （6.8%） （χ^2 =0.731,P 〈0.05）.Recurrence rates in biliary stone disease were significantly higher in patients with JPDD （19.5%） when compared to JPDD-lacking individuals （9.3%） （χ^2 =14.51,P 〈 0.05）.Conclusions JPDD is a risk factor for biliary stone formation.JPDD also is associated with post-ERCP pancreatitis,cannulation failure and biliary stone recurrence.