十二指肠乳头旁憩室与胆总管结石复发的相关性

The correlation between juxtapapillary duodenal diverticulum and biliary calculi recurrence

目的 研究十二指肠乳头旁憩室（juxtapapillary duodenal diverticulum,JPDD）与胆总管结石复发的相关性。方法 回顾性分析2009年10月至2013年10月于本院治疗的90例胆总管结石患者的临床资料,依据是否伴JPDD,将其分为JPDD组（46例）与非JPDD组（44例）,两组患者均予经内镜逆行胰胆管造影（endoscopic retrograde cholangio pancreatography,ERCP）、内镜下乳头括约肌切开术（endoscopic sphincterotomy,EST）取石、经内镜鼻胆管引流术（endoscopic nasobiliary drainage,ENBD）等检查及治疗。比较两组患者手术前后Oddi括约肌基础压（SOBP）、胆总管压（CBDP）、手术时间、术后引流量、血清总胆红素（TBIL）、直接胆红素（DBIL）、谷丙转氨酶（ALT）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（AKP）的变化情况及随访1-5年胆总管结石复发情况。结果 术前、术后3天,两组患者SOBP、CBDP比较均无显著差异（P〉0.05）。术后3天及1个月,两组患者SOBP、CBDP均低于术前（P〈0.05）,且术后1个月,非JPDD组患者SOBP、CBDP均显著低于JPDD组（P〈0.05）。非JPDD组患者手术时间、术后7天引流量均低于JPDD组（P〈0.05）。术后两组患者TBIL、DBIL、ALT、GGT、AKP水平均低于术前,且非JPDD组降低更明显（P〈0.05）。非JPDD组患者术后复发率低于JPDD组（P〈0.05）。结论 JPDD与胆总管结石复发具有相关性,可能与JPDD术后胆总管压力升高、引流量减少等因素有关。

ObjectiveTo research the correlation between juxtapapillary duodenal diverticulum （JPDD） and the recurrence of common bile duct stones.MethodA retrospective analysis about 90 patients with calculus of common bile duct in our hospital from October 2009 to October 2013 was conducted, according to whether with JPDD, they were divided into JPDD group （n=46） and non-JPDD group （n=44）. Patients of the two groups were treated with endoscopic retrograde cholangio pancreatography （ERCP）, endoscopic sphincterotomy （EST） and endoscopic nasobiliary drainage （ENBD）. Changes of sphincter of Oddi basal pressure （SOBP）, common bile duct pressure （CBDP）, operation time, postoperative drainage volume, serum total bilirubin （TBIL）, direct bilirubin （DBIL）, alanine aminotransferase （ALT）, gamma glutamyl transpeptidase （GGT）, alkaline phosphatase （AKP） of the two groups before and after surgery were compared, recurrence of calculus of common bile duct were followed up from 1 to 5 years.ResultSOBP, CBDP were not signiifcantly different between the two groups before surgery and 3 days after surgery. SOBP and CBDP of the two groups were lower than before surgery （P〈0.05）, SOBP and CBDP of non-JPDD group were signiifcantly lower than JPDD group 1 month after surgery （P〈0.05）. Operation time and postoperative drainage volume of 7 days after surgery of non-JPDD group were significantly lower than JPDD group （P〈0.05）. The levels of TBIL, DBIL, ALT, GGT, AKP after surgery of the two groups were lower than before surgery. Postoperative recurrence rate of non-JPDD group was lower than JPDD group （P〈0.05）. ConclusionJPDD is associated with recurrence of calculus of common bile duct, that may be caused by postoperative CBDP rise, drainage volume reduced and other factors.