十二指肠乳头旁憩室的潜在临床意义及对ERCP诊疗的影响分析  

The potential clinical significance of juxtapapillary duodenal diverticulum and its influence on the diagnosis and treatment of ERCP

作　　者：矫元君 尹耀新[1] 李桂贤[1] 刘吉奎[1] 林齐睿 JIAO Yuan-jun;YIN Yao-xin;LI Gui-xian(Department of Hepatobiliary and Pancreatic Surgery,Peking University Shenzhen Hospital,Shenzhen 518000,China)

机构地区：[1]北京大学深圳医院肝胆胰外科,518000

出　　处：《中国实用医药》2022年第11期9-13,共5页China Practical Medicine

基　　金：深圳市医疗卫生三名工程项目(项目编号:SZSM201612021)。

摘　　要：目的 探讨十二指肠乳头旁憩室(JPDD)的潜在临床意义及对经内镜逆行胰胆管造影术(ERCP)诊疗的影响。方法 427例行ERCP患者,根据有无JPDD分为憩室组(104例)、无憩室组(323例);憩室组按十二指肠乳头在憩室内或外分成憩室内型组(14例)、憩室外型组(90例)。比较憩室组与无憩室组、憩室内型组与憩室外型组性别、年龄、原发性胆总管结石发生率、一次性取石成功率、术中情况[行经内镜乳头括约肌切开取石术(EST)、经内镜鼻胆管引流术(ENBD)]、术后并发症(出血、胰腺炎、高淀粉酶血症)发生率。结果 憩室组平均年龄(60.76±15.2)岁、年龄≥60岁占比59.62%、原发性胆总管结石发生率41.35%均高于无憩室组的(50.25±15.78)岁、29.72%、25.39%,差异具有统计学意义(P<0.05)。憩室组与无憩室组性别、一次性取石成功率、术中行EST占比、术中行ENBD占比及术后出血、胰腺炎、高淀粉酶血症发生率比较差异无统计学意义(P>0.05)。憩室内型组平均年龄、年龄≥60岁占比高于憩室外型组,但差异无统计学意义(P>0.05)。憩室内型组与憩室外型组性别、原发性胆总管结石发生率、一次性取石成功率、术中行EST占比、术中行ENBD占比及术后出血、胰腺炎、高淀粉酶血症发生率比较差异无统计学意义(P>0.05)。结论 JPDD与原发性胆总管结石的发生有关,随着年龄的增长出现JPDD的可能性增加。不同憩室分型对胆总管结石形成的影响是否存在不同,可能还需要多中心大数据的分析来证实。Objective To discuss the potential clinical significance of juxtapapillary duodenal diverticulum(JPDD) and its influence on the diagnosis and treatment of endoscopic retrograde cholangiopancreatography(ERCP). Methods A total of 427 patients with ERCP were divided into diverticulum group(104 cases) and non-diverticulum group(323 cases) according to the presence or absence of JPDD. The diverticulum group was divided into intradiverticular papilla group(14 cases) and externaldiverticular papilla group(90 cases) according to the duodenal papilla inside or outside the diverticulum. The gender, age, incidence of primary choledocholithiasis, success rate of one-time stone removal, and intraoperative conditions [endoscopic sphincterotomy(EST), endoscopic nasobiliary drainage(ENBD)], occurrence of postoperative complications(bleeding, pancreatitis, hyperamylasemia) were compared between the diverticulum group and non-diverticulum group, intradiverticular papilla group and externaldiverticular papilla group. Results The average age of the diverticulum group was(60.76±15.2) years old, the proportion of patients aged ≥60 years was 59.62%, and the incidence of primary choledocholithiasis was 41.35%, which were higher than(50.25±15.78) years old,29.72%, and 25.39% of the non-diverticulum group, and the difference was statistically significant(P<0.05).There was no statistically significant difference between the diverticulum group and the non-diverticulum group in terms of gender, success rate of one-time stone removal, intraoperative EST percentage, intraoperative ENBD percentage, and incidence of postoperative bleeding, pancreatitis, and hyperamylasemia(P>0.05). The average age and the proportion of patients aged ≥60 years in the intradiverticular papilla group were higher than those in the externaldiverticular papilla group, but the difference was not statistically significant(P>0.05). There was no statistically significant difference between the intradiverticular papilla group and the externaldiverticular papilla grou

关 键 词：十二指肠乳头旁憩室 经内镜逆行胰胆管造影术 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]