胆道疾病与十二指肠乳头周围憩室关系的研究  

The relationship between duodenal diverticulum in the peri-ampullary region and biliary diseases

作　　者：吴硕东[1] 田雨[1] 苏洋[1] 张振海[1] 王昊霖[1] 张立魁[1] 刘博[1] 

机构地区：[1]中国医科大学附属盛京医院第一微创,胆道外科,辽宁沈阳110004

出　　处：《外科理论与实践》2007年第4期342-344,共3页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨十二指肠乳头周围憩室与各种胆道疾病,尤其是胆管胆色素结石的关系。方法:回顾性分析2003年8月至2006年5月所进行的逆行胰胆管造影或Oddi括约肌切开术的178例病人,根据胆道疾病的种类分组并观察与十二指肠乳头周围憩室的关系。结果:81例原发性胆管胆色素结石病人中有44例存在十二指肠乳头周围憩室(54.32%);8例胆管合并胆囊结石的病人中有4例(50.00%);33例继发于胆囊结石的胆管结石病人中有7例(21.21%);21例胆管末端和乳头部炎性狭窄的病人中有3例(14.29%);22例肝内胆管癌、乳头癌及胆管末端癌病人中有1例(4.54%);13例胆囊切除术后综合征或SOD组中有5例(38.46%)。结论:胆管胆色素结石病人同时患十二指肠乳头周围憩室者明显多于继发于胆囊结石的胆管结石组、胆管末端和乳头部炎症狭窄组及胆管末端癌和乳头癌组,提示十二指肠乳头周围憩室和其可能导致的Oddi括约肌结构及功能异常,可能是原发性胆管胆色素结石发生的重要原因。Objective To explore the relationship between duodenal diverticulum in the peri-ampullary region and biliary diseases, including the formation of pigment gallstones. Methods One hundred and seventy-eight cases of endoscopic retrograde cholangiopancreatography （ERCP） or endoscopic sphincterotomy were analyzed retrospectively. The cases were divided into 6 groups according to the category of biliary diseases and the incidence of duodenal diverticulum in the peri-ampullary region. Results The number of patients with primary choledochal pigment stones concomitant with the existence of duodenal diverticulum in the peri-ampullary region was 44 （44/81 or 54.32%）, while those in patients concomitant with both choledochal and gallbladder stones, choledochal stones migrated from the gallbladder, inflammation and stricture of the lower extremity of the choledochus and the papilla, cancer of the lower choledochus and the papilla, and post-cholecystectomy syndrome were 4（4/8 or 50.00%）, 7（7/33 or 21.21%）, 3 （3/21 or 14.29%）, 1（1/22 or 4.54%） and 5（5/ 13 or 38.46%）, respectively. Conclusions The incidence of duodenal diverticulum in the peri-ampullary region concomitant with primary choledochal pigment stones was higher than that with inflammation and stricture of the lower extremity of the choledochus and the papilla, with cancer of the lower extremity of the choledochus and the papilla, and with choledochal stones migrated from the gallbladder. The structure and function of Oddi sphincter appear to have an intimate relationship with, and might play an important role in the formation of bile duct pigment stones.

关 键 词：胆道疾病 十二指肠乳头周围憩室 胆结石 胰胆管造影术 内窥镜逆行 奥狄括约肌 

分 类 号：R657.4[医药卫生—外科学]