十二指肠乳头旁憩室与胆结石的关系（附92例分析）

目的 探讨十二指肠憩室在胆结石发病中的作用。方法 回顾性分析广州市番禺中心医院行逆行胰胆管造影检查的462例患者，其中合并乳头憩室92例（憩室组），无合并乳头憩室370例（非憩室组）。分析比较两组患者年龄、胆结石的发病率、结石发生部位及结石成分方面的差异。结果 本组462例患者中，憩室组92例，占19.9%。憩室组平均年龄61.8岁，明显高于非憩室组(61.8 vs 51.2岁，P<0.O1)，且憩室发生率随年龄的增大而增高(P<0.01)。本组发现患者中，72例十二指肠憩室合并胆结石，憩室合并胆结石发生率78.3%，而非憩室组370例中仅97例合并胆结石，占26.2%。十二指肠憩室组并结石的发生率明显高于非憩室组。本组中乳头旁憩室胆结石发生率明显高于乳头周围型憩室者，有显著性差异。乳头旁憩室患者的原发性胆总管结石发生率明显高于继发性胆总管结石及胆囊结石，且结石成分主要为胆色素结石。结论 十二指肠乳头旁憩室患者胆结石发病率显著增高，且主要与原发性胆总管结石相关。

Relationship between duodenal para-papillary diverticula and biliary calculi (Analysis of 92 cases)

Objective To investigate the influence of duodenal diverticulum on the formation of biliary calculi.Methods A data of consecutive patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) from Jan 2002 to Jan 2009 were analyzed retrospectively.The relationship between duodenal diverticulum and biliary calculi was investigated and analyzed.Results Ninety-two cases with duodenal diverticulum were found in the examination of a total 462 subjects,including 67 cases of juxtapapillary duodenal diverticulum(JDD) and 25 cases of periampullary diverticula.Of these 92 cases,72 were complicated with biliary calculi(78.3%,72 /92),in which JDD was complicated in 59 cases(88.06%,59/67),periampullary diverticulum was in 8 cases(32%,8/32).However,97 cases were found biliary calculi in the same period of non-duodenal diverticulum subjects(26.2%,97/370).The incidence of bile pigment stone in JDD was 54.17%(26/48),and that of cholesterol stone was 45.83%(22/48).The incidence of bile pigment stone in periampullary diverticula was 28%(7/25),and that of cholesterol stone was 72%(18/25).Conclusion In our data of the ERCP examination,the patients of duodenal diverticulum had a higher incidence of gallstones as compared to those patients with non-duodenal diverticulum.