十二指肠乳头旁憩室与胆总管结石的关系及其对经内镜逆行胰胆管造影术取石效果的影响

Relation Between Periampullary Diverticula and Choledocholithiasis and the Effect of Periampullary Diverticula on Removing Calculus by Endoscopic Retrograde Cholangiopancreatography

目的探讨十二指肠乳头旁憩室(PAD)与胆总管结石的关系及其对经内镜逆行胰胆管造影术(ERCP)取石效果的影响。方法回顾性分析2011年7月—2013年7月厦门大学附属中山医院所有接受ERCP的351例患者的临床资料。按照是否发生PAD分为PAD组(67例)和非PAD组(284例)。分析并比较PAD组与非PAD组胆总管结石发生率、不同PAD与十二指肠乳头相对位置(包绕型、并列型、边缘型)患者胆总管结石发生率、合并胆总管结石患者ERCP取石效果(取石成功率、术后并发症)。结果两组患者性别、年龄、胆总管结石发生率比较,差异有统计学意义(P<0.05);两组患者恶性肿瘤、Oddi括约肌功能障碍、慢性胰腺炎、高血压、糖尿病、心脏病发生率比较,差异无统计学意义(P>0.05)。PAD发生率随年龄的增大而升高(P<0.05)。边缘型PAD患者胆总管结石发生率高于包绕型、并列型(P<0.05)。PAD合并胆总管结石患者与非PAD合并胆总管结石患者取石成功率、术后急性胰腺炎发生率、术中少量出血发生率比较,差异无统计学意义(P>0.05)。结论 PAD可能是胆总管结石的病因之一;PAD对ERCP取石效果的影响是有限的,只要熟练掌握内镜下操作技巧,注意手术方式,ERCP取石对PAD合并胆总管结石仍是一种安全、有效的治疗手段。

Objective To explore the relation between periampullary diverticula（ PAD） and choledocholithiasis and the effect of PAD on removing calculus by endoscopic retrograde cholangiopancreatography（ ERCP）. Methods The clinical data of 351 patients who received ERCP in Zhongshan Hospital Xiamen University from July 2011 to July 2013 were analyzed retrospectively. The patients were divided into PAD group（ n = 67） and non PAD group（ n = 284） according to whether the patients suffered from PAD. The occurrence rate of choledocholithiasis was analyzed and compared between PAD group and non PAD group and among patients with different relative locations（ circumvolution type,parallel type,marginal type） between PAD and duodenal papilla; the effect of removing calculus（ success rate of removing calculus and postoperative complications） by ERCP was analyzed and compared between PAD patients accompanied by choledocholithiasis and non PAD patients accompanied by choledocholithiasis. Results The difference was significant in sex,age and the occurrence rate of choledocholithiasis between the two groups（ P〈0. 05）. The occurrence rates of malignant tumor, Oddi sphincter dysfunction, chronic pancreatitis,hypertension,diabetes and cardiopathy were not significantly different between the two groups（ P〈0. 05）. The occurrence rate of PAD increased with age（ P〈0. 05）. The occurrence rate of choledocholithiasis of marginal type PAD patients was higher than that of circumvolution type PAD patients and parallel type PAD patients（ P〈0. 05）. The difference in the success rate of removing calculus,the occurrence rate of acute pancreatitis after operation and the occurrence rate of bleeding during operation were not significantly different between PAD patients accompanied by choledocholithiasis and non PAD patients accompanied by choledocholithiasis（ P〈0. 05）. Conclusion PAD might be one of the reasons of choledocholithiasis,and the effect of PAD on removing calculus by ERCP is limited. As long as the skills of endoscopy are grasped and the manner of operation is paid attention,removing calculus by ERCP is still a safe and effective treatment method for PAD patients accompanied by choledocholithiasis.