内镜逆行胆胰管造影术在胆总管结石合并壶腹部憩室中的应用  

Application of endoscopic retrograde cholangiopancreatography to common bile duct stones with periampullary diverticulum

作　　者：曹占国[1] 李宁[1] 王震宇[1] 赵宏志[1] Cao Zhanguo;Li Ning;Wang Zhenyu;Zhao Hongzhi(Minimally Invasive Surgical Center,Tianjin NanKai Hospital,Tianjin 300100,China)

机构地区：[1]天津市南开医院微创外科,300100

出　　处：《中华消化内镜杂志》2018年第7期503-506,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨经内镜逆行胆胰管造影术（ERCP）在胆总管结石合并壶腹部憩室（PAD）患者中的安全性及有效性。方法回顾性分析2013年4月至2016年3月2103例因胆总管结石于天津市南开医院首次行ERCP患者的临床资料，所有患者按照是否存在壶腹部憩室分为壶腹部憩室组（PAD组）和非壶腹部憩室组（非PAD组）。比较两组患者ERCP的成功率、首次内镜净石率及困难插管率。结果PAD组困难ERCP插管率（14．87％，117／787）明显高于非PAD组（9．93％，123／1239）（P=0．001）。PAD组ERCP成功率（96．92％，787／812）与非PAD组（95．97％，1239／1291）差异无统计学意义（P=0．156）。PAD组首次内镜净石率（672／787，85．39％）与非PAD组（1079／1239，87．09％）差异无统计学意义（P=0．154）。在ERCP后早期总并发症（如胰腺炎、出血及消化道穿孔等）发生率上PAD组（26／812，3．20％）与非PAD组（33／1291，2．56％）差异无统计学意义（P=0．833）。结论壶腹部憩室虽然增加了操作的难度，但ERCP对治疗胆总管结石合并壶腹部憩室患者是安全有效的，是治疗胆总管结石的首选方式。Objective To explore the safety and effectiveness of endoscopic retrograde cholangiopancreatography （ERCP） for bile duct stones with periampullary diverticula （PAD）. Methods Data of 2,103 patients with common bile duct stones（ CBD stones）, who underwent therapeutic ERCP for the first time from April 2013 to March 2016, were prospectively analyzed. Patients were divided into two groups according to presence or absence of PAD （PAD group and non-PAD group ）. Success rate of ERCP, complete clearance rate of the CBD stones after the first attempt and difficult cannulation rate were compared between the two groups. Results The difficult CBD cannulation rate was 14. 87% （117/787） in PAD group and 9. 93% （ 123/1 239 ） in non-PAD group with significant difference （ P = 0. 001 ）. Successful CBD cannulation was achieved in 96. 92% （787/812） patients in PAD group and 95.97% （1 239/1 291 ） in non-PAD group （P= 0. 156）. The complete clearance rate of CBD stones after the first attempt was 85.39% （672/787） in PAD group and 87.09% （1 079/1 239）in non-PAD group （P= 0. 154）. There was no significant difference between the two groups in the complication rate [ 26/812 （3.20%） VS 33/1 291 （ 2. 56% ）, P = 0. 833 ]. Conclusion Although PAD increases the difficulty of ERCP, ERCP is an effective and safe method for patients of CBD stones with PAD.

关 键 词：胆胰管造影术 内窥镜逆行 胆总管结石病 憩室 

分 类 号：R575.7[医药卫生—消化系统]