Tzeng Jeng-Jie, Lai Kwok-Hung, Peng Nan-Jing, Lo Gin-Ho, Lin Chiun-Ku, Chan Hoi-Hung, Hsu Ping-I, Cheng Jin-Shiung, Wang E-Ming
Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
J Gastroenterol Hepatol. 2005 May;20(5):772-6. doi: 10.1111/j.1440-1746.2005.03782.x.
The role of juxtapapillary diverticulum ( JPD) in biliary stone formation is controversial. This study was designed to understand the relationship between the size of JPD, hepatic clearance and recurrent bile duct stones in patients after endoscopic sphincterotomy.
Five hundred and twenty patients with choledocholithiasis who had received endoscopic sphincterotomy were enrolled. They were divided into three groups: group A (n = 268) without diverticula; group B (n = 156) with small diverticula; and group C (n = 96) with large diverticula. All patients were regularly followed with interviews, liver function test and sonogram to detect the recurrent bile duct stones. Quantitative cholescintigraphy was performed in 176 cholecystectomized patients to evaluate the hepatic clearance. Sphincter of Oddi manometry was performed to exclude incomplete sphincterotomy if quantitative cholescintigraphy was abnormal.
After 9-111 months of follow-up, 76 patients had recurrent bile duct stones. There was a significant higher bile duct stone recurrence in group C than in group A (P < 0.01), but no statistical difference was noted between group B and group A (P = 0.2). Patients with JPD were older than those without (P < 0.05). Of 176 cholecystectomized patients, two were excluded because sphincter of Oddi basal pressure was more than 10 mmHg. In the remaining 174 patients, the E45' was significantly lower in group C than in group A (41.2% +/- 18.6%vs 49.1% +/- 14.1%; P < 0.05), and there was no significant difference between group B and group A.
JPD is a predisposing factor of delayed biliary emptying and it increases the chance and incidence of recurrent bile duct stones.
乳头旁憩室（JPD）在胆石形成中的作用存在争议。本研究旨在了解内镜括约肌切开术后患者JPD大小、肝脏清除率与胆管结石复发之间的关系。
纳入520例接受内镜括约肌切开术的胆总管结石患者。他们被分为三组：A组（n = 268）无憩室；B组（n = 156）有小憩室；C组（n = 96）有大憩室。所有患者均通过访谈、肝功能检查和超声定期随访，以检测胆管结石复发情况。对176例胆囊切除患者进行定量胆系闪烁造影以评估肝脏清除率。如果定量胆系闪烁造影异常，则进行Oddi括约肌测压以排除括约肌切开不完全。
随访9 - 111个月后，76例患者出现胆管结石复发。C组胆管结石复发率显著高于A组（P < 0.01），但B组与A组之间无统计学差异（P = 0.2）。有JPD的患者比无JPD的患者年龄更大（P < 0.05）。在176例胆囊切除患者中，2例因Oddi括约肌基础压力超过10 mmHg而被排除。在其余174例患者中，C组的E45'显著低于A组（41.2% ± 18.6%对49.1% ± 14.1%；P < 0.05），B组与A组之间无显著差异。
JPD是胆汁排空延迟的一个易感因素，它增加了胆管结石复发的机会和发生率。
