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目的 探讨十二指肠憩室在胆结石发病中的作用。方法 回顾性分析我院行逆行胰胆管造影(ERCP)检查的167例患者,其中合并乳头憩室31例(憩室组),无合并乳头憩室136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167例患者中,合并乳头憩室31例,占18.56％。憩室组平均年龄62岁,明显高于非憩室组的52岁(P<0.01),且憩室发生率随年龄的增大而增高。本组发现的86例胆结石患者中24例合并十二指肠憩室,胆结石并憩室发生率27.9％;而非结石组81例中仅7例合并十二指肠憩室,占8.6％。结石组并十二指肠憩室的发生率明显高于非结石组(P<0.05)。本组中乳头旁憩室胆结石发生率(100％)明显高于乳头周围型憩室者(46.2％),有显著性差异(P<0.05)。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。
Objective To investigate the role of duodenal diverticulum in the pathogenesis of gallstones. Methods Retrospective analysis of 167 patients with retrograde cholangiopancreatography (ERCP) in our hospital, including 31 cases of papillary diverticulum (diverticulum group), 136 cases without papillary diverticulum (non-diverticulum group). Analysis of the two groups of patients age, the incidence of gallstones, stones and stone parts of the differences. Results 167 patients in this group, 31 cases of papillary diverticulum, accounting for 18.56%. The average age of diverticular group was 62 years, significantly higher than that of non-diverticulum group (P <0.01), and the incidence of diverticulum increased with age. Among the 86 patients with gallstones found in this group, 24 cases had duodenal diverticula and gallbladder with diverticulum rate of 27.9%. Only 7 of 81 patients with non-calculus group combined with duodenal diverticulum, accounting for 8.6%. The incidence of stone group and duodenal diverticulum was significantly higher than that of non-stone group (P <0.05). In this group, the incidence of papillary diverticulum gallbladder (100%) was significantly higher than that of peripheral type of diverticulum (46.2%), there was a significant difference (P <0.05). The incidence of primary common bile duct stones in patients with parapharyngeal diverticulum was significantly higher than that of secondary common bile duct stones and gallbladder stones, and the main components of stones were bile pigment stones. Conclusions The incidence of gallstones in patients with duodenal papillary diverticulitis is significantly higher than that in primary duodenal stones.