十二指肠乳头旁憩室在急性结石性胆管炎发病中的意义

Juxtapaillary duodenal diverticula in patients of acute calculous cholangitis

目的探讨十二指肠乳头旁憩室（juxtapapillary duodenal diverticula，JPDD）在不同程度急性结石性胆管炎中的临床意义。方法回顾性分析2011年1月至2013年12月间东阳市人民医院收治并施行十二指肠镜治疗的急性结石性胆管炎病例488例，分析其临床资料。结果本组488例患者JPDD检出率在I级、Ⅱ级、Ⅲ级结石性胆管炎患者中分别为2．87％、6．15％、4．10％：111级胆管炎JPDD检出率比Ⅱ级、I级胆管炎JPDD检出率高（χ2=4．486，P=0．034；χ2=14．686，P〈0．001）；JPDD组Ⅲ级胆管炎血浆降钙素原（procalcitouin，PCT）值高于Ⅱ级、I级胆管炎血浆PCT值（t=10．4209，P〈0．001；t=4．8704，P〈0．001）。有JPDD组插管失败例数及术后24h淀粉酶水平高于无JPDD组（χ2=36．95，P〈0．001；t=8．29，P〈0．001）。结论JPDD检出率与患者年龄、胆管炎严重程度有关，可能影响其血浆PCT值；JPDD可能会增加增加十二指肠镜插管失败率及术后24h淀粉酶水平。

Objective To evaluate the clinical significance of juxtapaillary duodenal diverticula （JPDD） in patients of acute calculous cholangitis （AC） with different severity grade. Methods A retrospective analysis was carried out for 488 AC cases of different severity from January 2011 to December 2013 who underwent duodenoseopy in Dongyang People＇s Hospital. Results Of the 488 patients, the JPDD was found in 2. 87%, 6. 15% and 4. 10% in patients with mild, moderate and severe AC, respectively. The prevalence of JPDD in severe AC were significantly higher in the moderate and mild AC （χ2 = 4. 486, P = 0. 034 ;χ2 = 14. 686, P 〈 0. 001 ） ; Procalcitoniu （PCT） concentrations in severe AC of JPDD were significantly higher in moderate and mild AC of JPDD （ t = 10. 420 9, P 〈 0. 001 ; t = 4. 870 4, P 〈 0. 001 ）. The cannulation failure rate and the amylase were significantly higher in JPDD patients compares to patients without JPDD （χ2 = 36. 95, P 〈 0. 001 ; t = 8.29, P 〈 0. 001 ）. Conclusions JPDD detection rate increases with aging and seems to be associated with acute cholangitis （AC） with different severity grade and PCT concentration. JPDD predicts a higher cannulation failure rate and the amylase level after duodenoscopy.