十二指肠憩室对胆石病内镜下治疗的影响  

Effect of Duodenal Diverticulum on Endoscopic Therapy for Cholelithiais

作　　者：马升高[1] 郭保华[1] 吴建胜[2] 吴明[2] 

机构地区：[1]铁岭市中心医院消化内科,辽宁铁岭112000 [2]温州医学院附属第一院消化内科,浙江温州325000

出　　处：《实用临床医学（江西）》2011年第7期11-13,36,共4页Practical Clinical Medicine

摘　　要：目的探讨十二指肠憩室与胆石病的关系及其对诊疗性内镜逆行性胰胆管造影(ERCP)的影响。方法对100例行内镜下十二指肠乳头切开、胆总管取石术的胆石症患者的临床资料进行回顾性分析。结果 100例胆石病患者并发十二指肠憩室41例,发生率为41%。41例并发十二指肠憩室患者行ERCP,造影成功率100%。其中6例十二指肠乳头球囊扩张术后,取石成功;35例进行十二指肠乳头切开术(EST)及取石术,其中34例胆总管结石一次取净,1例因结石较大未能取出,给予放置塑料支架引流,3个月后取石成功。血常规和生化指标检测结果:100例患者术后第2天与术前比较WBC、GPT和GOT下降不明显(均P>0.05),碱性磷酸酶(AKP)、r-谷氨酰转肽酶(r-GT)、总胆红素(TB)和直接胆红素(DB)较术前明显下降(均P<0.05)。术后无出血、穿孔及死亡病例。结论十二指肠憩室是胆石病的重要诱因,给诊疗性ERCP带来困难和风险,但只要操作者耐心、细心、小心,即使是治疗性ERCP也是安全的。Objective To investigate the relationship between duodenal diverticulum and cholelithiais,and to observe the effect of duodenal diverticulumon on diagnostic and therapeutic endoscopic retrograde cholangiopancreatography（ERCP）.Methods One hundred patients with cholelithiais who underwent endoscopic sphincterotomy and choledochotomy were retrospectively analyzed.Results Among the 100 patients,cholelithiasis complicated with duodenal diverticulum occurred in 41 patients with an incidence of 41%.Among the 41 patients who underwent ERCP,bile duct visualization was found in 100%,and stones were successfully extracted after endoscopic balloon dilation in 6 patients.Among the 35 patients underwent endoscopic sphincterotomy（EST） and choledochotomy,stones were removed by one operation in 34 patients.A plastic stent was placed for drainage in 1 patient who had larger stones and the stones were removed after three months.Compared with preoperative levels,WBC,GPT and GOT did not decreased on postoperative day 2（all P0.05）,but AKP,r-GT,TB and DB decreased significantly（all P0.05）.No bleeding,perforation and death occurred in all patients.Conclusion Duodenal diverticulum is an important inducement of cholelithiasis and makes diagnostic and therapeutic ERCP riskier and more difficult.However,as long as the operator is patient and cautious,therapeutic ERCP can be safely performed.

关 键 词：十二指肠憩室 胆石病 逆行性胰胆管造影 

分 类 号：R745.51[医药卫生—神经病学与精神病学]