十二指肠乳头旁憩室对ERCP手术治疗胆总管结石患者效果的影响

Impact of periampullary diverticula on surgical efficacy of ERCP in dealing with patients with choledocholithiasis

目的分析十二指肠乳头旁憩室(PAD)对内镜下逆行胰胆管造影术(ERCP)治疗胆总管结石患者手术的影响。方法2016年12月~2019年12月我院消化内科诊治的胆总管结石合并PAD患者101例(憩室内乳头37例,非憩室内乳头64例)和胆总管结石患者174例。所有患者在ERCP下插管、取石治疗。结果憩室组和非憩室组插管成功率分别为95.1%和98.4%,取石成功率分别为91.1%和92.0%,差异无统计学意义(P>0.05);术后,憩室组与非憩室组并发症发生率为19.8%和19.0%,差异无统计学意义(P>0.05);憩室内乳头组插管成功率为86.5%,取石成功率为81.1%,均显著低于非憩室内乳头组的100.0%和96.9%(P<0.05);术后,憩室内乳头组与非憩室内乳头组并发症发生率分别为24.3%和17.2%,差异无统计学意义(P>0.05)。结论PAD会对ERCP手术治疗胆总管结石患者的效果产生一定的不利影响,尤其是憩室内乳头会增加插管难度,降低取石成功率,需要医生提高手术技巧,才能获得手术的成功。

Objective The aim of this study was to analyze the impact of periampullary diverticula(PAD)on surgical efficacy of endoscopic retrograde cholangiopancreatography(ERCP)in dealing with patients with choledocholithiasis.Methods A total of 275 patients with choledocholithiasis were admitted to our hospital between December 2016 and December 2019,and the presence of PAD were found in 101 patients,a papillary diverticulum in 37 cases and non-papillary diverticulum in 64 cases.All patients underwent ERCP for removal of stones.Results The success rates of intubation in patients with PAD and without PAD were 95.1%and 98.4%,respectively,and the success rates of stone removal in the two groups were 91.1%and 92.0%,respectively(P>0.05);the total incidence rate of postoperative complications was 19.8%in patients with and was 19.0%in patients without PAD(P>0.05);the success rate of intubation and success rate of stone removal in patients with papillary diverticulum were significantly lower than those with non-papillary diverticulum(86.5%vs.100.0%and 81.1%vs.96.9%,respectively,P<0.05);the total incidence rate of postoperative complications in patients with papillary diverticulum was 24.3%,not significantly different compared to 17.2%in patients with non-papillary diverticulum(P>0.05).Conclusion PAD has a certain influence on surgical intubation of ERCP for treatment of patients with choledocholithiasis,especially in those with papillary diverticulum,which could increase the difficulty of intubation and reduce the success rate of stone removal.The clinicians should practice for it as proficiently as possible.