内镜诊治十二指肠乳头旁憩室256例分析

Endoscopic diagnosis and therapy for papillary duodenal diverticula: analysis of 256 cases

摘要:

目的 探讨十二指肠憩室与胆道结石的关系及经内镜逆行胰胆管造影术（ERCP）及内镜下乳头括约肌切开术（EST）对十二指肠乳头旁憩室合并胆总管结石的诊治方法。方法 回顾性分析2005年12月~2012年6月该院ERCP诊疗1560例，总结分析乳头旁憩室的临床资料及对ERCP成功率、EST及其并发症的影响。结果 ERCP发现十二指肠乳头旁憩室256例，占ERCP检查总数的16.4%（256/1 560），十二指肠乳头旁憩室合并胆总管结石195例，占76.2%（195/256）。ERCP造影成功率94.1%（241/256），实施EST188例，全部成功，内镜取石成功率85.1%（166/195）。ERCP术后并发症7.0%（18/256）。结论 十二指肠憩室与胆道结石关系密切，内镜治疗是十二指肠乳头旁憩室合并胆总管结石的微创、安全、有效的首选治疗手段。

Abstract:

【Objective】 To study the clinical relationship between duodenal diverticulum and cholelithiasis; to study methods of diagnosis and values of endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy(EST) for periampullary duodenal diverticula combined with common bile duct stones. 【Methods】 From December 2005 to July 2012, totally 1560 patients received ERCP were retrospectively analyzed, including the clinical data of 256 cases of periampullary diverticula, the effects of periampullary diverticula on the success rate of ERCP, EST and complications were reviewed. 【Results】 256 cases of periampullary diverticula took 16.4% of the ERCP(256/1560), of which 76.2%(195/256) were complicated with common bile duct stones. The success rate of ERCP was 94.1% (241/256); and the stones were removed successfully by endoscope in 166 of 195 patients (85.1%). The 188 EST cases were all succeeded. The postoperative complication of ERCP was 7.0%(18/256). 【Conclusion】 There is a close clinical relationship between periampullary diverticula and cholelithiasis. ERCP and EST therapy is a safe, minimally invasive and effective treatment to cure periampullary diverticula complicated with common bile duct stones.