十二指肠乳头部憩室的诊断与治疗

目的　总结十二指肠乳头部憩室 (JPD)的诊断和治疗经验。方法　在 4 2 80例逆行胰胆管造影术 (ERCP)检查中发现JPD 192例。根据十二指肠乳头与憩室的位置关系将其分类。对其中 83例行各种手术治疗。结果　可将憩室分为二种类型。乳头外型 :憩室位于乳头周围 ,共 12 5例 ( 65 .1% )。其中 3 1例 ( 2 4 .8% )因憩室炎、憩室出血、穿孔或合并胆结石等并发症行手术治疗。乳头内型 :乳头在憩室内 ,共 67例 ( 3 4.9% ) ,其中 5 2例 ( 77.6% )因伴有返流性胆管炎、胰腺炎、胆囊或胆管结石行各种手术治疗。结论　ERCP是诊断JPD的主要方法。根据乳头与憩室的关系 ,可将憩室分为乳头外型和乳头内型。JPD中若合并严重憩室炎、憩室出血、穿孔或胆胰疾病特别是胆结石者 ,常需外科治疗。

Diagnosis and treatment of juxta-ampullary duodenal diverticula

Objective To summarize the experience of diagnosis and treatment of juxta ampullary duodenal diverticula (JPD). Method Among 4 280 consecutive endoscopic retrograde cholangiopancreatography (ERCP) at our center, 192 patients with JPD were found and treated. All patients were classified according to the location of papilla of Vater in relation with duodenal diverticula. Eighty three were managed with various operations. Results One hundred and ninety two patients with JPD were divided into two types. Type A (125 cases, 65.1%): the papillae were near the diverticulum or its margin. Of these, 31 patients (24.8%) presenting with diverticulitis, bleeding, perforation or cholelithiasis were operated upon. Type B (67 cases, 34.9%): the papillae were within the diverticulum. Among them, 52 cases (77.6%) had complications of recurrent cholangitis, pancreatitis or cholelithiasis and required surgical operation. Conclusions ERCP was the major method of diagnosis of JPD, and JPD could be divided into two types, those with severe complications need surgical intervention.