CAJ | 학술논문

目的探讨十二指肠乳头旁憩室(JPDD)与胆总管结石的关系,及其对内镜乳头括约肌切开术(EST)治疗和并发症的影响.方法回顾性分析行EST治疗合并JPDD的胆总管结石51例患者(合并JPDD胆总管结石组)和未合并JPDD胆总管结石210例患者(未合并JPDD胆总管结石组)的临床资料,探讨JPDD与胆总管结石发病的关系,分析JPDD对内镜下逆行胰胆管造影术(ERCP)插管成功率、EST取石成功率及其并发症的影响.结果 JPDD直径＜1 cm、1～3cm、＞3 cm合并胆总管结石发病率分别为39.3％(11/28),53.2％(33/62),7/8,JPDD直径越大,合并胆总管结石发病率越高,差异有统计学意义(P＜0.01).JPDD合并胆总管结石发病率边缘型[81.0％(17/21)]显著高于并列型[41.9％(26/62)]和包绕型(8/15),差异有统计学意义(P＜0.05).合并JPDD胆总管结石组与未合并JPDD胆总管结石组ERCP插管成功率比较差异无统计学意义(P＞0.05),而合并JPDD胆总管结石组EST取石成功率明显低于未合并JPDD胆总管结石组[91.8％(45/49)比99.5％(208/209)],EST切口出血发生率明显高于未合并JPDD胆总管结石组[11.1％(5/45)比1.9％(4/208)],差异有统计学意义(P＜0.01);两组其他并发症发生率比较差异无统计学意义(P＞0.05).Logistic回归分析显示JPDD是EST切口出血的独立危险因素(P=0.043).结论 JPDD特点与胆总管结石发病率相关;EST治疗胆总管结石会受到JPDD的影响,但仍是治疗合并JPDD胆总管结石的一种相对安全有效的方法.
목적 탐토십이지장유두방게실(JPDD)여담총관결석적관계,급기대내경유두괄약기절개술(EST)치료화병발증적영향.방법 회고성분석행EST치료합병JPDD적담총관결석51례환자(합병JPDD담총관결석조)화미합병JPDD담총관결석210례환자(미합병JPDD담총관결석조)적림상자료,탐토JPDD여담총관결석발병적관계,분석JPDD대내경하역행이담관조영술(ERCP)삽관성공솔、EST취석성공솔급기병발증적영향.결과 JPDD직경＜1 cm、1～3cm、＞3 cm합병담총관결석발병솔분별위39.3％(11/28),53.2％(33/62),7/8,JPDD직경월대,합병담총관결석발병솔월고,차이유통계학의의(P＜0.01).JPDD합병담총관결석발병솔변연형[81.0％(17/21)]현저고우병렬형[41.9％(26/62)]화포요형(8/15),차이유통계학의의(P＜0.05).합병JPDD담총관결석조여미합병JPDD담총관결석조ERCP삽관성공솔비교차이무통계학의의(P＞0.05),이합병JPDD담총관결석조EST취석성공솔명현저우미합병JPDD담총관결석조[91.8％(45/49)비99.5％(208/209)],EST절구출혈발생솔명현고우미합병JPDD담총관결석조[11.1％(5/45)비1.9％(4/208)],차이유통계학의의(P＜0.01);량조기타병발증발생솔비교차이무통계학의의(P＞0.05).Logistic회귀분석현시JPDD시EST절구출혈적독립위험인소(P=0.043).결론 JPDD특점여담총관결석발병솔상관;EST치료담총관결석회수도JPDD적영향,단잉시치료합병JPDD담총관결석적일충상대안전유효적방법.
Objective To investigate the relationship between juxtapapillary duodenal diverticular (JPDD) and choledocholithiasis,and the effects of JPDD on endoscopic sphinctemtomy(EST) in treatment of choledocholithiasis.Methods Fifty-one cases of choledocholithiasis combined with JPDD (choledocholithiasis combined with JPDD group) and 210 cases of choledocholithiasis without JPDD (choledocholithiasis without JPDD group) were treated by EST,and the clinical data of patients in the two groups were retrospectively analyzed.The relationship between JPDD and choledocholithiasis was studied.The JPDD' influence on the intubation success rate of endoscopic retrograde cholangiopancreatography (ERCP),the success rate of the stone removal by EST and complication were analyzed.Results The incidences of choledocholithiasis in patients of JPDD diameter ＜ 1 cm,1-3 cm and ＞ 3 cm were 39.3％(11/28),53.2％ (33/62) and 7/8 respectively.The larger the JPDD diameter,the higher the incidence of choledocholithiasis,and there was statistical difference (P ＜ 0.01).The incidence of choledocholithiasis in peripheral type JPDD was significantly higher than that in parallel type and circumvolution type [81.0％(17/21) vs.41.9％(26/62) and 8/15],and there were statistical differences (P ＜0.05).There was no statistical difference in the intubation success rate of ERCP between the two groups (P ＞ 0.05),but the success rate of the stone removal by EST in choledocholithiasis combined with JPDD group was significantly lower than that in choledocholithiasis without JPDD group [91.8％ (45/49) vs.99.5％ (208/209)].The incidence of EST incision bleeding was significantly higher than that in choledocholithiasis without JPDD group [11.1％ (5/45) vs.1.9％ (4/208)],and there was statistical difference (P ＜ 0.01) ; there were statistical differences in the incidences of others complication between the two groups (P ＞ 0.05).Logistic regression analysis showed that JPDD was independent risk factor for EST incision bleeding (P =0.043).Conclusions JPDD is relative with choledocholithiasis.JPDD makes EST a little more difficult and risky,while EST is still a safe and effective therapy for choledocholithiasis patients combined with JPDD.