中国医学前沿杂志（电子版）
中國醫學前沿雜誌（電子版）
중국의학전연잡지（전자판）
Chinese Journal of the Frontiers of Medical Science (Electronic Version)
2015年
9期
88-91
,共4页
十二指肠乳头旁憩室%胆总管结石%经内镜逆行胰胆管造影%内镜下乳头括约肌切开术
十二指腸乳頭徬憩室%膽總管結石%經內鏡逆行胰膽管造影%內鏡下乳頭括約肌切開術
십이지장유두방게실%담총관결석%경내경역행이담관조영%내경하유두괄약기절개술
Juxtapapillary duodenal diverticulum%Calculus of common bile duct%Endoscopic retrograde cholangiopancreatography%Endoscopic sphincterotomy
目的：研究十二指肠乳头旁憩室（juxtapapillary duodenal diverticulum，JPDD）与胆总管结石复发的相关性。方法回顾性分析2009年10月至2013年10月于本院治疗的90例胆总管结石患者的临床资料，依据是否伴JPDD，将其分为JPDD组（46例）与非JPDD组（44例），两组患者均予经内镜逆行胰胆管造影（endoscopic retrograde cholangio pancreatography，ERCP）、内镜下乳头括约肌切开术（endoscopic sphincterotomy，EST）取石、经内镜鼻胆管引流术（endoscopic nasobiliary drainage， ENBD）等检查及治疗。比较两组患者手术前后Oddi括约肌基础压（SOBP）、胆总管压（CBDP）、手术时间、术后引流量、血清总胆红素（TBIL）、直接胆红素（DBIL）、谷丙转氨酶（ALT）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（AKP）的变化情况及随访1～5年胆总管结石复发情况。结果术前、术后3天，两组患者SOBP、CBDP比较均无显著差异（P＞0.05）。术后3天及1个月，两组患者SOBP、CBDP均低于术前（P＜0.05），且术后1个月，非JPDD组患者SOBP、CBDP均显著低于JPDD组（P＜0.05）。非JPDD组患者手术时间、术后7天引流量均低于JPDD组（P＜0.05）。术后两组患者TBIL、DBIL、ALT、GGT、AKP水平均低于术前，且非JPDD组降低更明显（P＜0.05）。非JPDD组患者术后复发率低于JPDD组（P＜0.05）。结论 JPDD与胆总管结石复发具有相关性，可能与JPDD术后胆总管压力升高、引流量减少等因素有关。
目的：研究十二指腸乳頭徬憩室（juxtapapillary duodenal diverticulum，JPDD）與膽總管結石複髮的相關性。方法迴顧性分析2009年10月至2013年10月于本院治療的90例膽總管結石患者的臨床資料，依據是否伴JPDD，將其分為JPDD組（46例）與非JPDD組（44例），兩組患者均予經內鏡逆行胰膽管造影（endoscopic retrograde cholangio pancreatography，ERCP）、內鏡下乳頭括約肌切開術（endoscopic sphincterotomy，EST）取石、經內鏡鼻膽管引流術（endoscopic nasobiliary drainage， ENBD）等檢查及治療。比較兩組患者手術前後Oddi括約肌基礎壓（SOBP）、膽總管壓（CBDP）、手術時間、術後引流量、血清總膽紅素（TBIL）、直接膽紅素（DBIL）、穀丙轉氨酶（ALT）、γ-穀氨酰轉肽酶（GGT）、堿性燐痠酶（AKP）的變化情況及隨訪1～5年膽總管結石複髮情況。結果術前、術後3天，兩組患者SOBP、CBDP比較均無顯著差異（P＞0.05）。術後3天及1箇月，兩組患者SOBP、CBDP均低于術前（P＜0.05），且術後1箇月，非JPDD組患者SOBP、CBDP均顯著低于JPDD組（P＜0.05）。非JPDD組患者手術時間、術後7天引流量均低于JPDD組（P＜0.05）。術後兩組患者TBIL、DBIL、ALT、GGT、AKP水平均低于術前，且非JPDD組降低更明顯（P＜0.05）。非JPDD組患者術後複髮率低于JPDD組（P＜0.05）。結論 JPDD與膽總管結石複髮具有相關性，可能與JPDD術後膽總管壓力升高、引流量減少等因素有關。
목적：연구십이지장유두방게실（juxtapapillary duodenal diverticulum，JPDD）여담총관결석복발적상관성。방법회고성분석2009년10월지2013년10월우본원치료적90례담총관결석환자적림상자료，의거시부반JPDD，장기분위JPDD조（46례）여비JPDD조（44례），량조환자균여경내경역행이담관조영（endoscopic retrograde cholangio pancreatography，ERCP）、내경하유두괄약기절개술（endoscopic sphincterotomy，EST）취석、경내경비담관인류술（endoscopic nasobiliary drainage， ENBD）등검사급치료。비교량조환자수술전후Oddi괄약기기출압（SOBP）、담총관압（CBDP）、수술시간、술후인류량、혈청총담홍소（TBIL）、직접담홍소（DBIL）、곡병전안매（ALT）、γ-곡안선전태매（GGT）、감성린산매（AKP）적변화정황급수방1～5년담총관결석복발정황。결과술전、술후3천，량조환자SOBP、CBDP비교균무현저차이（P＞0.05）。술후3천급1개월，량조환자SOBP、CBDP균저우술전（P＜0.05），차술후1개월，비JPDD조환자SOBP、CBDP균현저저우JPDD조（P＜0.05）。비JPDD조환자수술시간、술후7천인류량균저우JPDD조（P＜0.05）。술후량조환자TBIL、DBIL、ALT、GGT、AKP수평균저우술전，차비JPDD조강저경명현（P＜0.05）。비JPDD조환자술후복발솔저우JPDD조（P＜0.05）。결론 JPDD여담총관결석복발구유상관성，가능여JPDD술후담총관압력승고、인류량감소등인소유관。
ObjectiveTo research the correlation between juxtapapillary duodenal diverticulum (JPDD) and the recurrence of common bile duct stones.MethodA retrospective analysis about 90 patients with calculus of common bile duct in our hospital from October 2009 to October 2013 was conducted, according to whether with JPDD, they were divided into JPDD group (n=46) and non-JPDD group (n=44). Patients of the two groups were treated with endoscopic retrograde cholangio pancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD). Changes of sphincter of Oddi basal pressure (SOBP), common bile duct pressure (CBDP), operation time, postoperative drainage volume, serum total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), alkaline phosphatase (AKP) of the two groups before and after surgery were compared, recurrence of calculus of common bile duct were followed up from 1 to 5 years.ResultSOBP, CBDP were not signiifcantly different between the two groups before surgery and 3 days after surgery. SOBP and CBDP of the two groups were lower than before surgery (P<0.05), SOBP and CBDP of non-JPDD group were signiifcantly lower than JPDD group 1 month after surgery (P<0.05). Operation time and postoperative drainage volume of 7 days after surgery of non-JPDD group were significantly lower than JPDD group (P<0.05). The levels of TBIL, DBIL, ALT, GGT, AKP after surgery of the two groups were lower than before surgery. Postoperative recurrence rate of non-JPDD group was lower than JPDD group (P<0.05). ConclusionJPDD is associated with recurrence of calculus of common bile duct, that may be caused by postoperative CBDP rise, drainage volume reduced and other factors.
