十二指肠乳头旁憩室伴胆胰疾病的诊断及外科治疗  

Diagnosis and surgical treatment of the parapapillary duodenal diverticulum complicated with pancreaticobiliary diseases

作　　者：张国伟[1] 周杰[1] 廖彩仙[1] 赵国湘[1] 

机构地区：[1]第一军医大学附属南方医院肝胆血管外科,广州510515

出　　处：《中国实用外科杂志》2004年第2期99-100,共2页Chinese Journal of Practical Surgery

摘　　要：目的　探讨十二指肠乳头旁憩室伴胆胰疾病的诊断、手术治疗方法。方法　回顾性分析 1977～ 2 0 0 2年手术治疗的 5 0例十二指肠乳头旁憩室伴胆胰疾病者的临床表现、诊断及治疗方法。结果　症状性十二指肠乳头旁憩室缺乏特异性临床表现 ,多以上腹痛为首发症状 ,常伴有寒战、发热、黄疸、恶心、呕吐等消化道症状。上消化道钡餐造影、十二指肠镜、ERCP确诊率高。十二指肠乳头旁憩室一旦出现严重的临床症状及并发症首先考虑手术治疗。结论　十二指肠镜、上消化道钡餐造影为诊断十二指肠乳头旁憩室的首选检查方法 ,强调根据病人具体情况制定“个体化手术治疗方案” ,其中Billroth Ⅱ式胃大部切除和 (或 )胆总管 空肠Roux en Y吻合术疗效满意。应重视乳头旁憩室与胆胰疾病的关系。对伴有胆胰疾病的乳头旁憩室的处理应持积极态度 ,手术是首选治疗方法。Objective To evaluate the methods of diagnosis and choice of treatment for the parapapillary duodenal diverticulum complicated with pancreaticobiliary diseases. Methods From 1977 to 2002, The clinical manifestation, diagnosis and therapy of 50 patients with parapapillary duodenal diverticulum complicated with pancreaticobiliary diseases treated in our hospital were reviewed. Results Symptomatic parapapillary duodenal diverticulum lacked in specific clinical manifestation .Usually, epigastric pain was the first symptom, accompanied by chill, fever, jaundice, nausea and vomitting. Upper gastrointestinal radiography, duodenoscopy and ERCP had a high rate of correction in the diagnosis of the disease. Surgical therapy should be performed as soon as severe clinical manifestation or complications occurred. Conclusion Duodenoscopy and upper gastrointestinal radiography are the first choice for diagnosis of parapapillary duodenal diverticulum. For patients with parapapillary duodenal diverticulum surgical treatment should follow the principle of individualized therapy. Gastrojejunostomy and (or) Roux-en-Y choledochojejunostomy are effective treatment. Relation between parapillary diverticulum and pancreaticobiliary diseases should be considered.Operation is a primary way to treat parapillary diverticulum complicated with panreaticobiliary diseases.

关 键 词：十二指肠乳头 十二指肠憩室 胆胰疾病 十二指肠镜检查 上消化道钡餐造影 外科治疗 Billroth-Ⅱ式胃大部切除术 胆总管-空肠Roux-en-Y吻合术 

分 类 号：R656.64[医药卫生—外科学] R657.4[医药卫生—临床医学]