十二指肠乳头异位于球部的内镜诊断和治疗

Endoscopic Diagnosis and Treatment of Ectopia of Duodenal Papilla in the Duodenal Bulb

目的:探讨十二指肠乳头异位于球部的内镜诊断和治疗。方法:回顾性分析2016年2月-2019年2月本院消化内镜中心收治的11例十二指肠乳头异位于球部患者的临床资料,分析患者的疾病特点及内镜治疗情况,随访内镜术后胆管炎及胆总管结石复发情况。结果:11例均以胆管炎、胆总管结石为诊断入院,其中9例本次入院有右上腹痛、皮肤巩膜黄染、发热、寒战,6例既往有反复发作胆管炎表现。10例完成内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)手术,均于内镜下于十二指肠球部发现乳头开口,并经造影证实与胆管相通,10例均合并胆总管结石和胆总管末端狭窄,6例合并有十二指肠球部狭窄,采用内镜下乳头开口球囊扩张取石术,部分大结石采用机械碎石后取石,均无严重并发症发生。1例ERCP未成功者进行外科手术治疗。所有患者均获得随访,ERCP术后有3例再发胆管炎有胆总管结石,后转外科手术治疗;3例反复再发胆管炎但无胆总管结石,经内科治疗好转。结论:十二指肠乳头异位于球部虽少见但需引起重视,特别是反复发作胆管炎及有消化性溃疡病史患者,以及在十二指肠降段未见到正常乳头结构的患者,这类患者中部分进行ERCP治疗是有效的,但应根据具体情况综合考虑选择ERCP治疗或者外科手术治疗。

Objective:To investigate the endoscopic diagnosis and treatment of ectopic of duodenal papilla in the duodenal bulb.Method:The clinical data of 11 patients with ectopic of duodenal papilla in the duodenal bulb in the digestive endoscopy center of our hospital from February 2016 to February 2019 were retrospectively analyzed.The disease characteristics and endoscopic treatment of the patients were analyzed,and the recurrence of cholangitis and choledocholithiasis after endoscopic surgery was followed up.Result:All 11 cases were admitted with cholangitis and choledocholithiasis as diagnoses,of which 9 cases had right upper abdominal pain,yellow skin and sclera,fever and chills on this admission,and 6 cases had recurrent manifestations of cholangitis in the past.Endoscopic retrograde cholangiopancreatography(ERCP)was performed in 10 cases.The opening of the papilla was found in the duodenal bulb under endoscope,and it was confirmed by cholangiography that it communicated with the bile duct.Ten cases were complicated with choledocholithiasis and stenosis of the end of the common bile duct,6 cases were complicated with duodenal bulb stenosis.Endoscopic balloon dilatation of the opening of the papilla was used for stone extraction,and some large stones were treated with mechanical lithotripsy.No serious complications occurred.One case with unsuccessful ERCP underwent surgical treatment.All cases were followed up.After ERCP,3 cases had recurrent cholangitis and choledocholithiasis and were transferred to surgery;3 cases had recurrent cholangitis but no choledocholithiasis and were improved by medical treatment.Conclusion:Although ectopic of duodenal papilla in the duodenal bulb is rare,it needs attention,especially in patients with recurrent cholangitis and a history of peptic ulcer disease,as well as in patients without normal papillary structure in the descending duodenum,some ERCP treatments are effective in such patients,but ERCP or surgical treatment should be considered comprehensively according to specific circumstances.