伴有壶腹周围憩室的胆总管结石特点及其对ERCP操作和相关并发症的影响

摘要/Abstract

摘要： 目的分析伴壶腹周围憩室(PAD)患者胆总管结石的临床资料,探讨其结石特点、ERCP相关操作参数及并发症发生率,为临床实践提供循证依据。方法收集2022年12月至2024年12月于本院接受ERCP治疗的120例胆总管结石患者临床资料,其中合并PAD 21例(17.5%),比较合并、未合并PAD患者一般资料、ERCP操作相关资料及并发症发生情况。结果与未合并PAD比,合并PAD患者既往胆囊切除例数、结石长径、结石枚数以及胆总管直径等比较差异具有统计学意义(P<0.05)。与未合并PAD比,合并PAD患者球囊扩张直径、术中出血、内镜下塑料支架置入、内镜下鼻胆管引流、机械碎石、结石取净、插管困难、插管时间以及手术时间等比较差异具有统计学意义(P<0.05)。治疗期间发生的并发症包括术后胰腺炎、术后胆道感染、壶腹周围穿孔及高淀粉酶血症。与未合并PAD比,合并PAD患者高淀粉酶血症以及总体并发症例数明显增加(P<0.05)。结论 PAD作为一种常见但复杂的解剖变异,与胆总管结石的形成密切相关,显著增加ERCP操作的技术难度及术后并发症风险。

关键词: 胆总管结石, 壶腹周围憩室, 高淀粉酶血症

Abstract: Objective To analyze the clinical data of patients with common bile duct stones accompanied by periampullary diverticulum, investigate the characteristics of the stones, ERCP-related procedural parameters, and complication rates, and provide evidence-based guidance for clinical practice. Methods A total of 120 patients with CBD stones who underwent ERCP between December 2022 and December 2024 were retrospectively analyzed in our hospital. Among them, 21 patients (17.5%) had concomitant PAD. General clinical characteristics, ERCP-related procedural data, and complications were compared between patients with and without PAD. Results Compared with patients without PAD, those with PAD had significantly higher rates of prior cholecystectomy, longer stone length, greater number of stones, and larger CBD diameter (P<0.05). PAD patients also had significantly larger balloon dilation diameters, increased intraoperative bleeding, higher rates of plastic stent placement and nasobiliary drainage, increased need for mechanical lithotripsy, lower stone clearance rates, greater difficulty in cannulation, longer cannulation time, and prolonged procedure time compared to those without PAD (P<0.05). Complications during treatment included post-ERCP pancreatitis, biliary tract infection, periampullary perforation, and hyperamylasemia. PAD patients showed a significantly higher incidence of hyperamylasemia and total complication rate compared to those without PAD (P<0.05). Conclusion PAD, as a common but complex anatomical variation, is closely associated with the formation of CBD stones and significantly increases the technical difficulty of ERCP and the risk of postoperative complications.

Key words: Common bile duct stones, Periampullary diverticulum, Hyperamylasemia

刘鑫, 王晓娟, 韩素燕, 杜娟. 伴有壶腹周围憩室的胆总管结石特点及其对ERCP操作和相关并发症的影响[J]. 肝脏, 2025, 30(12): 1720-1723.

LIU Xin, WANG Xiao-juan, HAN Su-yan, DU Juan. Characteristics of common bile duct stones with periampullary diverticulum and their impact on ERCP procedure and related complications[J]. Chinese Hepatolgy, 2025, 30(12): 1720-1723.

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