十二指肠乳头旁憩室致复发性胆管结石40例疗效

Surgical treatment of recurrent cholelithiasis caused by peripapillary duodenal diverticulum

目的探讨十二指肠乳头旁憩室致复发性胆管结石的诊断和治疗。方法回顾性分析2010年11月至2014年11月河南省人民医院收治的40例因十二指肠乳头旁憩室致反复胆管结石发作患者的临床资料，并对相关治疗情况进行归纳总结。结果所有患者均行十二指肠憩室化手术，其中21例加行胆管空肠R—Y吻合术；14例行胆管切开探查取石T管引流术，5例行十二指肠切开术和Oddi括约肌切开成形术。40例患者术后临床症状基本消失，行胆管空肠肠吻合患者有3例出现一过性胆漏，通畅引流后痊愈。除2例失联外，所有患者经3年随访，余38例并未见结石复发，患者主观感觉良好，疗效满意。结论十二指肠乳头旁憩室是复发性胆管结石的一个不可忽视的病因，在十二指肠憩室化基础上的胆道相关手术是治疗此种疾病的有效方法。

Objective To study the diagnosis and therapy of recurrent cholelithiasis caused by peri- papillary duodenal diverticulum. Methods The clinical data of 40 patients with repeated formation of bile duct stones caused by peripapillary duodenal diverticulum were retrospectively reviewed, and the data on sur- gical treatment were analyzed. Results All the patients underwent duodenal diverticulum operation and subtotal gastrectomy （Billroth ]I ）. Twenty-one patients in addition underwent R-Y cholangiojejunostomy, 14 patients and 5 patients underwent choledochotomy with T-tube drainage and duodenotomy with Oddi sphincterotomy, respectively. In forty patients, three patients presented temporarily biliary fistula, two pa- tients lost touch, three-eighty fully recover from an illness in three years. Conclusion Recurrence of bile duct stones caused by peripapillary diverticulum may be cured by duodenal diverticulum operation combined with bile duct surgery, which is a feasible and efficacious treatment.