十二指肠乳头旁憩室合并胆总管结石的诊治  

Diagnosis and treatment of juxtapapillary duodenal diverticulum complicated with choledocholithiasis

作　　者：付文广[1] 黎靖[1] 温剑[1] 莫利峰 叶明新[1] 李秋[1] 淦宇[1] 蒋禹[1] 雷正明[1] 

机构地区：[1]泸州医学院附属医院肝胆外科,四川泸州646000

出　　处：《海南医学》2015年第6期870-872,共3页Hainan Medical Journal

摘　　要：目的探讨十二指肠乳头旁憩室（Juxtapapillary duodenal diverticulum,JPDD）合并胆总管结石的诊断及治疗。方法回顾分析近12年来我院收治的17例JPDD合并胆总管结石临床资料。结果 17例JPDD合并胆总管结石患者,均有不同程度的腹痛、发热、黄疸或者胆道感染的病史,其中9例复发胆总管结石在第一次手术后0.5～3年（平均为1.2年）即再次出现胆道结石或胆道感染的症状。所有病例均行手术治疗,治愈出院。术后随访率为76.47%（13/17）。中位随访时间为26个月（3～78个月）。胆总管切开取石的4例随访患者中2例恢复良好,2例患者偶有胆管感染症状发作,经消炎、利胆等治疗后缓解。行胆管空肠Roux-en-Y吻合8例随访患者中2例患者偶感上腹部不适,经对症治疗后缓解,其余患者随访情况良好。结论胆总管结石形成、复发与JPDD有密切联系。胆总管结石的诊治过程中应考虑合并存在JPDD的可能,切忌只顾取石而忽视胆管末端狭窄和畸形的处理。对合并存在JPDD的胆总管结石患者行胆囊切除、胆总管空肠Roux-en-Y吻合术可获得较好疗效。Objective To investigate the diagnosis and treatment of juxtapapillary duodenal diverticulum（JPDD） complicated with choledocholithiasis. Methods The clinical data of 17 patients with JPDD complicated with choledocholithiasis in our hospital in the past 12 years were retrospectively analyzed. Results Different degrees of abdominal pain, fever, jaundice or a history of biliary tract infections were found in 17 cases, and symptoms of cholelithiasis or biliary tract infection were found again in 9 recurrent choledocholithiasis cases 6 to 36 months（1.2 years in mean） after the first operation. All patients were performed surgical treatment, cured and discharged. The postoperative follow-up rate was 76.47%（13/17）, and the follow-up period was 3 to 78 months, with a mean of 26 months.Among 4 cholecystectomy cases, 2 cases recovered well, while the other 2 cases were found with occasional infection of the bile duct（the symptoms were relieved after anti-inflammatory and cholagogic treatment）. Among 8 patients who received bile duct jejunum Roux-en-Y anastomosis, 6 patients were in good condition, while the other 2 patients were found with occasional abdominal discomfort（the symptoms were relieved after treatment）. Conclusion The formation and recurrence of choledocholithiasis are closely related to JPDD. JPDD should be taken into consideration while diagnosing and treating choledocholithiasis. Stenosis or deformity of the distal bile duct should not be ignored while removing stones. Therefore, cholecystectomy and common bile duct jejunum Roux-en-Y anastomosis can contribute to better prognosis of JPDD complicated with choledocholithiasis

关 键 词：十二指肠乳头旁憩室 胆总管结石 诊断 治疗 

分 类 号：R656.64[医药卫生—外科学]