十二指肠乳头旁憩室对ERCP临床诊治的影响

Infl uence of juxtapapillary duodenal diverticulum on diagnostic and therapeutic performance of endoscopic retrograde cholangiopancreatography

目的探讨十二指肠乳头旁憩室(juxtapapillary duodenal diverticulum,JDD)对内镜下逆行胰胆管造影(endoscopic retrograde cholangio pancreatography,ERCP)诊治的影响.方法对临沂市人民医院2006-01/2015-12之间进行共5673例ERCP合并JDD的1267例患者的临床资料进行回顾性分析,分析存在JDD对进行ERCP手术成功率以及并发症发生率的影响.结果本研究中行ERCP患者插管成功者为1242例,ERCP诊断JDD合并胆系结石者为1206例,占81%(1026/1267);非胆系结石的十二指肠憩室者为241例,占19%(241/1267),ERCP总的成功率98%(1242/1267).术中术后总的并发症47例(3.7%),术中出血者11例,术后迟发性出血者8例,ERCP术后胰腺炎者19例,胆道感染者7例,穿孔者2例,均经内镜或内科保守治疗后痊愈,整个过程中无死亡病例发生.结论JDD患者进行ERCP手术时应该更加谨慎的进行操作,了解这种解剖变异对胆管末端走行的影响,根据相应的乳头特点采取不同的操作方法,熟练掌握ERCP操作技巧,憩室旁乳头的ERCP相关操作也是可以安全顺利完成的.

AIM To assess the effect of juxtapapillary duodenal diverticulum（JDD） on the diagnostic and therapeutic performance of endoscopic retrograde cholangiopancreatography（ERCP）.METHODS A total of 5673 patients underwent ERCP at Linyi People＇s Hospital from January 2006 to December 2015,including 1267 cases with juxtapapiUary duodenal diverticulum.The clinical data for patients with juxtapapiUary duodenal diverticulum were analyzed retrospectively.The influence of duodenal diverticulum on the success rate of ERCP and the incidence of associated complications was analyzed.RESULTS Of the 1267 patients included,1242（98%）had successful intubation,1206（81%） were found to have biliary calculi during ERCP examination,241（19%） were found not to have biliary calculi.A total of 47 cases suffered from surgery associated complications（3.7%）,including 11 cases of intraoperative bleeding,8 cases of delayed postoperative hemorrhage,19 cases of pancreatitis after ERCP,7 cases of biliary tract infection,and 2cases of gastrointestinal perforation.No death occurred.CONCLUSION When ERCP examination is performed in patients with juxtapapillary duodenal diverticulum,endoscopists should be more cautious and have a better understanding that this anatomical variation may have an effect on the location of the distal end of the bile tract.Different methods of operation should be adopted according to the corresponding characteristics of the papilla.