十二指肠乳头旁憩室对 ERCP 治疗胆总管结石的影响。
The influence of periampullary diverticula on ERCP for treatment of common bile duct stones.
机构信息
Department of Gastroenterological Endoscopy, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan road, Xigang district, Dalian, 116011, Liaoning, China.
Department of Clinical Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.
出版信息
Sci Rep. 2020 Jul 10;10(1):11477. doi: 10.1038/s41598-020-68471-8.
In order to evaluate the effectiveness of various methods we applied to decrease the influence of periampullary diverticula (PAD) on the success rate and complications of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of common bile duct (CBD) stones, we enrolled patients with CBD stones who had been treated by ERCP in our hospital between January 2015 and December 2018. According to the presence of PAD, the patients were divided into a PAD group and a non-PAD group. The rate of complete stone removal in the first session, the rate of overall stone removal, the frequency of application of mechanical lithotripsy, and procedure-related complications, including bleeding, hyperamylasemia, pancreatitis, perforation, and infection of biliary tract were recorded. A total of 183 cases, including 72 cases in the PAD group and 111 cases in the non-PAD group were enrolled. There was no statistical difference between the two groups regarding gender (P = 0.354). However, regarding age, there was a statistical difference (P = 0.002), and the incidence of PAD increased with age. There were 5 (6.9%) cases in the PAD group and 14 (12.6%) cases in the non-PAD group where mechanical lithotripsy was applied. There were 59 (81.9%) cases in the PAD group and 102 (91.9%) cases in the non-PAD group where there was complete removal of CBD stones in the first session, and there were 68 (94.4%) cases in the PAD group and 107 (96.4%) cases in the non-PAD group where there was complete removal of all stones. In the PAD group, there were 0 cases (0%) with gastrointestinal bleeding, 0 cases (0%) with gastrointestinal perforation, 13 cases (18.1%) with post-ERCP hyperamylasemia, 3 cases (4.2%) with post-ERCP pancreatitis, and 4 cases (5.6%) with biliary tract infection. In the non-PAD group, 1 case (0.9%) had gastrointestinal bleeding, 0 cases had gastrointestinal perforation, 18 cases (16.2%) had post-ERCP hyperamylasemia, 5 cases (4.5%) had post-ERCP pancreatitis, and 11 cases (9.9%) had biliary tract infection. This retrospective study showed that there was a statistical difference between the two groups regarding complete removal of CBD stones in the first session and application of mechanical lithotripsy (both P < 0.05), but no statistical difference according to the rates of overall stone removal and the complications (P > 0.05), which means that we can reduce the influence of PAD on ERCP for treatment of common bile duct stones.
为了评估我们应用各种方法来降低十二指肠旁憩室（PAD）对内镜逆行胰胆管造影术（ERCP）治疗胆总管（CBD）结石成功率和并发症的影响的有效性，我们招募了 2015 年 1 月至 2018 年 12 月在我院接受 ERCP 治疗的 CBD 结石患者。根据 PAD 的存在，将患者分为 PAD 组和非 PAD 组。记录首次 session 中完全结石清除率、总体结石清除率、机械碎石应用频率以及与程序相关的并发症，包括出血、高淀粉酶血症、胰腺炎、穿孔和胆道感染。共纳入 183 例患者，其中 PAD 组 72 例，非 PAD 组 111 例。两组间性别无统计学差异（P=0.354）。然而，年龄有统计学差异（P=0.002），且 PAD 发生率随年龄增长而增加。PAD 组有 5 例（6.9%）和非 PAD 组有 14 例（12.6%）应用机械碎石。PAD 组有 59 例（81.9%）和非 PAD 组有 102 例（91.9%）在首次 session 中 CBD 结石完全清除，PAD 组有 68 例（94.4%）和非 PAD 组有 107 例（96.4%）所有结石完全清除。在 PAD 组中，有 0 例（0%）出现胃肠道出血，0 例（0%）出现胃肠道穿孔，13 例（18.1%）出现 ERCP 后高淀粉酶血症，3 例（4.2%）出现 ERCP 后胰腺炎，4 例（5.6%）出现胆道感染。在非 PAD 组中，有 1 例（0.9%）出现胃肠道出血，0 例出现胃肠道穿孔，18 例（16.2%）出现 ERCP 后高淀粉酶血症，5 例（4.5%）出现 ERCP 后胰腺炎，11 例（9.9%）出现胆道感染。这项回顾性研究表明，两组在首次 session 中 CBD 结石完全清除和机械碎石应用方面存在统计学差异（均 P<0.05），但在总体结石清除率和并发症方面无统计学差异（P>0.05），这意味着我们可以降低 PAD 对 ERCP 治疗胆总管结石的影响。
Zotero 插件