症状性十二指肠憩室的临床特点分析

目的探讨症状性十二指肠憩室病例的临床、内镜及影像学表现、治疗方法,并分析其临床意义。方法回顾性分析武汉大学人民医院2008年1月-2011年1月症状性十二指肠憩室病例,分析其临床表现、内镜及影像学表现、治疗方法等临床资料。结果共35例患者诊断为症状性十二指肠憩室,其中腹痛者15例、呕吐者2例、呕血或黑便者12例、黄疸患者6例,腹痛患者4例有反复发作史、黑便患者2例。所有病例中并发十二指肠憩室炎5例、急性胰腺炎1例、胆总管结石6例、肠梗阻1例、上消化道出血12例。35例症状性十二指肠憩室分别位于十二指肠球部9例、降部22例、水平部4例,其中单发25例、多发10例。经由消化道钡餐检查发现十二指肠憩室13例、胃镜9例、经内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)7例,双气囊小肠镜2例、腹部CT检查4例。结论十二指肠憩室症状不典型,对于不明原因上腹痛、消化道出血及胰腺炎患者,需考虑此病因,可行相关检查明确,治疗上除内科保守外还可以进行内镜下或者手术治疗。

Analysis of the clinical features of symptomatic duodenal diverticulum

Objective To investigate the clinical presentation,characteristics of endoscopy and imaging in patients symptomatic with duodenal diverticulum.Methods The clinical data of patients with symptomatic duodenal diverticulum in Renmin Hospital of Wuhan University from Jan.2008 to Jan.2011 were retrospectively reviewed.Results Among the 35 patients with symptomatic duodenal diverticulum,15 cases suffered from abdominal pain,2 cases suffered from vomit,12 cases suffered from hematemesis or melena,6 cases suffered from jaundice,respectively.In all cases,there were 5 cases of duodenal diverticulitis,1 case of acute pancreatitis,6 cases of choledocholithiasis,1 case of intestinal obstruction,and 12 cases of upper gastrointestinal bleeding.35 cases of symptomatic duodenal diverticulum patients were located in the duodenal bulb with 9 cases,in the duodenal descending part with 22 cases,in the horizontal part with 4 cases,respectively,including single of 25 cases and multiple of 10 cases.13 cases of duodenal diverticulum were found by the gastrointestinal barium meal examination,9 cases were found by gastroscopy examination,7 cases were found by endoscopic retrograde cholangiopancreatography(ERCP),2 cases were found by double-balloon enteroscopy,and 4 cases were found by abdominal CT scan,respectively.Conclusion The symptomatic duodenal diverticulum are not typical.Patients with unexplained upper abdominal pain,gastrointestinal bleeding and pancreatitis should be suspected of duodenal diverticulum.Conservative,endoscopic and surgical treatments are all used to treat duodenal diverticulum.