胆管结石合并十二指肠乳头旁憩室对内镜 下逆形胰胆管造影术的影响及对策

Influences and strategies of juxtapapillary diverticula in ERCP choledocholithiasis treatment

摘要:

目的 探讨胆管结石合并十二指肠乳头旁憩室（juxtapapillary duodenal diverticula, JPD）对内镜下逆行胰胆管造影术（encoscopic retrograde cholangio-pancreatography, ERCP）的影响及应对策略。 方法 回顾分析该院2006年6月~2012年12月1 042例胆管结石（其中261例患者合并JPD）行内镜下逆行胰胆管造影术（ERCP）患者资料，分析胆管结石合并JPD对ERCP操作的影响及策略的选择。 结果 261例胆管结石并发十二指肠憩室患者行（ERCP），造影成功率96.9％（253/261）。95.3%（241/253）患者胆总管结石一次取净，4.7%（12/253）因结石较大未能取出，给予放置塑料支架引流，3～6个月后其中8例取石成功，4例转行手术。并发一过性胆管炎2.0%（5/253），并发胰腺炎4.3%（11/253），其中1例重症胰腺炎。发生十二指肠乳头括约肌切开术（EST）术后出血3例（1.2%）（2例术中出血，1例迟发出血），无术后穿孔及死亡病例。 结论 胆管结石合并JPD行ERCP，术中选择有效策略有助于提高插管成功率，避免或减少并发症发生。

Abstract:

【Objective】 To investigate the influences and strategies of periampullary diverticula in endoscopic retrograde cholangiopancreatography (ERCP) treatment for choledocholithiasis. 【Methods】 Data of 1042 choledcholithiasis patients underwent ERCP, from June 2005 to October 2012 in our hospital, were collected and retrospectively analyzed. Of which, 261 cases were complicated with duodenal diverticulum. 【Results】 261 cases of cholecholithiasis were complicated with duodenal diverticulum, angiographic success rate was 96.9% (253/261), the stones were successfully removed in 241 patients and the rate of stones removed completely was 95.3% (241/253). Due to larger stones.12 patients were failure to remove the stone in one time and plastic stent drainage was performed, 3~6 months later, stones were successfully removed in 8 cases, 4 cases were conversed to surgery. 5 patients (2.0%) were complicated by transient cholanitis, 11 patients (4.3%) were complicated by pancreatitis, including 1 case of severe pancreatitis. Postopoerative bleeding occurred in 3 cases (1.2%). No postoperative duodenal perforation and perioperative death occurred. 【Conclusion】 Effective intraoperative strategies were very useful to improve intubation success rate, and reduce perioperative complications.