十二指肠乳头旁憩室致胆道梗阻的外科诊治
| 作者: |
1李镜华,
2吴韬,
2杨孔杰,
2杨永明
1 云南省大理市第二人民医院 普通外科，云南 大理 671003 2 昆明医科大学第一附属医院 肝胆外科，云南 昆明 650032 |
| 通讯: |
吴韬
Email: wutao7219@163.com |
| DOI: | 10.3978/.2018.02.016 |
摘要
目的：探讨十二指肠乳头旁憩室（JPPD）引起的胆道梗阻的合理诊断与治疗方法。
方法：结合文献资料，回顾分析昆明医科大学第一附属医院近年来收治的22例JPPD导致胆道梗阻的患者的临床资料。
结果：22例患者中，14例通过内镜逆行胰胆管造影（ERCP）检查确诊，8例通过磁共振胰胆管造影（MRCP）检查确诊；1例行单纯憩室切除术，2例行憩室切除+胆道探查术+T管引流术，15例行Billroth II式胃大部切除术+胆道探查术+T管引流术，3例行胆总管-空肠Roux-en-Y吻合术，1例行胰十二指肠切除术。20例获随访1.5~10年，恢复良好。
结论：对于JPPD引起的胆道梗阻，MRCP是目前确诊最佳方法，单纯憩室切除术最为理想；Billroth II胃大部切除术+胆道探查+T管引流术简单、安全、有效、应用最为广泛；Oddi括约肌狭窄者，可行胆总管-空肠Roux-en-Y吻合术。
关键词：
胆汁淤积/诊断；胆汁淤积/治疗；十二指肠乳头旁憩室；肝胰管壶腹
方法：结合文献资料，回顾分析昆明医科大学第一附属医院近年来收治的22例JPPD导致胆道梗阻的患者的临床资料。
结果：22例患者中，14例通过内镜逆行胰胆管造影（ERCP）检查确诊，8例通过磁共振胰胆管造影（MRCP）检查确诊；1例行单纯憩室切除术，2例行憩室切除+胆道探查术+T管引流术，15例行Billroth II式胃大部切除术+胆道探查术+T管引流术，3例行胆总管-空肠Roux-en-Y吻合术，1例行胰十二指肠切除术。20例获随访1.5~10年，恢复良好。
结论：对于JPPD引起的胆道梗阻，MRCP是目前确诊最佳方法，单纯憩室切除术最为理想；Billroth II胃大部切除术+胆道探查+T管引流术简单、安全、有效、应用最为广泛；Oddi括约肌狭窄者，可行胆总管-空肠Roux-en-Y吻合术。
Surgical diagnosis and treatment of biliary tract obstruction due to juxtapapillary duodenal diverticula
CorrespondingAuthor:WU Tao Email: wutao7219@163.com
Abstract
Objective: To investigate the appropriate methods of diagnosis and treatment for biliary tract obstruction secondary to juxtapapillary duodenal diverticula (JPPD).
Methods: The clinical data of 22 patients with JPPD caused biliary tract obstruction treated in the First Affiliated Hospital of Kunming Medical University in recent years were analyzed, along with literature review.
Results: Of the 22 patients, 14 cases were definitely diagnosed by endoscopic retrograde cholangiopancreatography (ERCP), 8 cases were confirmed by magnetic resonance cholangiopancreatography (MRCP); one case underwent diverticulum resection alone, 2 cases underwent diverticulum resection and choledochostomy with T-tube drainage, 15 cases underwent Billroth II gastrectomy and choledochostomy with T-tube drainage, 3 cases underwent Roux-en-Y choledochojejunostomy, and one case underwent pancreaticoduodenectomy. Twenty patients were followed up for 1.5 to 10 years, and all recovered well.
Conclusion: For JPPD caused biliary tract obstruction, MRCP is the best diagnostic method at present; simple diverticulum resection is the most ideal surgical approach, Billroth II gastrectomy and choledochostomy with T-tube drainage is a simple, safe and effective approach and is most widely used, and Roux-en-Y choledochojejunostomy can be performed for those with stenosis of the sphincter of Oddi.
Keywords：
Cholestasis/diag; Cholestasis/ther; Diverticulum; Ampulla of Vater
Methods: The clinical data of 22 patients with JPPD caused biliary tract obstruction treated in the First Affiliated Hospital of Kunming Medical University in recent years were analyzed, along with literature review.
Results: Of the 22 patients, 14 cases were definitely diagnosed by endoscopic retrograde cholangiopancreatography (ERCP), 8 cases were confirmed by magnetic resonance cholangiopancreatography (MRCP); one case underwent diverticulum resection alone, 2 cases underwent diverticulum resection and choledochostomy with T-tube drainage, 15 cases underwent Billroth II gastrectomy and choledochostomy with T-tube drainage, 3 cases underwent Roux-en-Y choledochojejunostomy, and one case underwent pancreaticoduodenectomy. Twenty patients were followed up for 1.5 to 10 years, and all recovered well.
Conclusion: For JPPD caused biliary tract obstruction, MRCP is the best diagnostic method at present; simple diverticulum resection is the most ideal surgical approach, Billroth II gastrectomy and choledochostomy with T-tube drainage is a simple, safe and effective approach and is most widely used, and Roux-en-Y choledochojejunostomy can be performed for those with stenosis of the sphincter of Oddi.