十二指肠乳头旁憩室合并胆胰疾病17例

目的：探讨十二指肠乳头旁憩室合并胆胰疾病的外科诊断和治疗。方法：回顾性分析2004年8月—2010年6月行外科治疗的17例十二指肠乳头旁憩室合并胆胰疾病患者的临床资料。结果：术前明确诊断12例,误诊率29.4%（5/17）,围手术期无死亡病例。患者行内镜下十二指肠乳头切开取石术2例,行憩室切除或憩室内翻缝合加Oddi括约肌成形术3例,胆总管探查术加毕罗Ⅱ式胃切除术6例,毕罗Ⅱ式胃切除术加胆肠Roux-Y吻合术4例,其中术前及术中均误诊2例,仅行胆总管探查术。憩室内翻缝合术后1例及误诊1例患者,因反复胆管炎发作而再次行胆肠Roux-Y吻合术。误诊1例患者,因反复憩室炎发作而二次行毕罗Ⅱ式胃切除术。毕罗Ⅱ式胃切除术后1例患者,出现胆管炎及憩室炎表现,因患者不能耐受再次手术而行保守治疗。结论：合并胆胰疾病的十二指肠乳头旁憩室患者容易误诊,保持警惕和完善的术前检查可提高确诊率。根据患者的具体病情,选择合理的手术方式是提高疗效的关键。

Experience of surgical diagnosis and treatment in juxtapapillary duodenal diverticula with pancreaticobiliary diseases

Objective: To explore the diagnosis and treatment experiences of Juxtapapillary duodenal diverticula with pancreaticobiliary diseases.Methods: Altogether 17 cases of Juxtapapillary duodenal diverticula with pancreaticobiliary diseases were treated by surgical treatment in our hospital from August 2004 to June 2010,retrospective study was used to analyze the clinical data of them.Results: Preoperative correct diagnosis in 12 cases,the misdiagnosis rate is 9.3%(5/17),patients perioperative no deaths(0/17).Endoscopic sphincterotomy in 2 patients,diverticulectomy and inversion suture﹢Oddi’s Sphincteroplasty in 3 patients,exploratory choledochotomy﹢Billroth-Ⅱ gastrectomy in 6 patients,Billroth-Ⅱ gastrectomy﹢Roux-en-Y choledochojejunostomy in 4 patients,only taken exploratory choledochotomy in 2 patients.For recurrent cholangitis 2 patients underwent reoperation with Roux-en-Y choledochojejunostomy.On account of diverticulitis,one patient performed reoperation with Billroth-Ⅱ gastrectomy.Although one patient experienced cholangitis and diverticulitis after operation,for cannot tolerate reoperation,only accepted conservative treatment.Conclusion: It is easy to be misdiagnosed that Juxtapapillary duodenal diverticula with pancreaticobiliary diseases,remain vigilant and perfect preoperative examination can improve diagnosis rate.According to the individualized condition,rational choice of surgical manner is the key to enhance the curative effect.