十二指肠乳头旁憩室对括约肌切开术治疗胰管结石的影响

Effect of parapillary diverticulum on endoscopic sphincterotomy in the treatment of pancreatic stones

目的探讨乳头旁憩室对内镜下括约肌切开术(endoscopic sphincterotomy,EST)治疗胰管结石及术后并发症的影响。方法回顾性分析194例胰管结石行内镜逆行胰胆管造影术(endoscopic retrograde cholangio-pancreatography,ERCP)治疗病例,其中无乳头旁憩室的胰管结石患者148例为对照组,46例合并乳头旁憩室为试验组;比较两组ERCP插管成功率、EST胰管取石成功率及并发症发生率。结果试验组与对照组ERCP插管成功率比较,差异无统计学意义(89.13%vs 89.19%,P>0.05),试验组EST取石成功率明显降低(90.24%vs 97.73%,P<0.05),试验组EST术后创面出血显著增多(13.04%vs 8.78%,P<0.01),术后胰腺炎及结石复发两组差异无统计学意义(P>0.05)。结论乳头旁憩室对EST治疗胰管结石有一定影响;EST仍是治疗乳头旁憩室胰管结石的一种相对安全、有效的手段。

Objective To investigate the effect of parapillary diverticulum on endoscopic sphincterotomy (EST) in the treatment of pancreatic stones and postoperative complications. Methods One hundred and ninety-four patients with pancreatic stones treated by ERCP were analyzed retrospectively. They were divided into control group (148 patients without parapillary diverticulum) and experimental group (46 patients with parapillary diverticulum). The success rates of ERCP intubation, EST pancreatic duct quarrying and complication rates were compared between the two groups. Results There was no significant difference in the success rate of ERCP intubation between the two groups (89.13% vs 89.19%, P >0.05). The success rate of EST quarrying in the experimental group was significantly reduced (90.24% vs 97.73%, P <0.05). There was a significant increase in wound hemorrhage after EST in the experimental group (13.04% vs 8.78%, P <0.01). There was no significant difference in the rate of post-operative pancreatitis and recurrence of stones between the two groups ( P >0.05). Conclusion Parapillary diverticulum has a certain effect on the treatment of pancreatic stones by EST which is still a relatively safe and effective method.