Lobo D N, Balfour T W, Iftikhar S Y
Department of Surgery, Nottingham City Hospital.
Ann R Coll Surg Engl. 1998 Sep;80(5):326-31.
Periampullary diverticula (PAD) are associated with biliary disease and contribute to failure of endoscopic retrograde cholangiopancreatography (ERCP), especially in elderly patients. The presence of PAD and causes of failure to cannulate the ampulla were noted in 1211 consecutive patients undergoing ERCP. Case notes of 100 consecutive patients with PAD were reviewed retrospectively. Overall prevalence of PAD was 9%. Prevalence was higher in patients > or = 75 years when compared with those < 75 years (19.2% vs 4.8%, P < 0.0001). Ampullary cannulation was successful in 62.4% of patients with PAD and 92.7% without PAD (P < 0.0001). Success rates were lower in patients with intradiverticular papillae than in those with juxtapapillary diverticula (38.1% vs 77.6%; P < 0.0001). Of 19 patients with PAD who did not have any imaging other than ultrasound, 16 were asymptomatic over a median follow-up of 20 months. Biliary surgery was performed on 35 patients, with no major complication. PAD are a major cause of failed ERCP. Failure rates are higher in patients with intradiverticular papillae than juxtapapillary diverticula. Though a large proportion of patients not imaged remain asymptomatic on follow-up, it is difficult to predict which patients may form this group. Surgery, when indicated, is safe and effective in elderly patients in whom ERCP has failed.
壶腹周围憩室（PAD）与胆道疾病相关，并且是导致内镜逆行胰胆管造影（ERCP）失败的原因之一，在老年患者中尤为如此。在连续接受ERCP的1211例患者中记录了PAD的存在情况及壶腹插管失败的原因。对100例连续的PAD患者的病历进行了回顾性分析。PAD的总体患病率为9%。与年龄<75岁的患者相比，年龄≥75岁的患者患病率更高（19.2%对4.8%，P<0.0001）。PAD患者的壶腹插管成功率为62.4%，无PAD患者的成功率为92.7%（P<0.0001）。憩室内乳头患者的成功率低于乳头旁憩室患者（38.1%对77.6%；P<0.0001）。在19例除超声外未进行任何影像学检查的PAD患者中，16例在中位随访20个月期间无症状。35例患者接受了胆道手术，无重大并发症。PAD是ERCP失败的主要原因。憩室内乳头患者的失败率高于乳头旁憩室患者。尽管很大一部分未进行影像学检查的患者在随访中无症状，但很难预测哪些患者属于这一组。在ERCP失败的老年患者中，手术在有指征时是安全有效的。
