【摘要】 目的 探讨十二指肠乳头旁憩室是否影响ERCP插管成功率、ERCP相关并发症发生率；十二指肠乳头旁憩室与梗阻性黄疸相关病因之间的关系及十二指肠乳头旁憩室发病率的影响因素。方法 回顾性分析2019年1月至2020年12月商丘市第一人民医院因梗阻性黄疸行ERCP诊疗的患者资料，按照纳入标准和排除标准进行筛选，根据是否合并十二指肠乳头旁憩室分为憩室组和非憩室组。统计分析憩室组和非憩室组之间性别、年龄、ERCP插管成功率、ERCP相关并发症发生率是否有差异，两组之间梗阻性黄疸病因有无差异。结果 筛选出符合入组标准者311例，其中憩室组160例，非憩室组151例。通过手术及病理检查，301例患者得以明确梗阻性黄疸病因，而10例患者未能明确梗阻性黄疸病因。在梗阻性黄疸的病因中，胆总管结石275例，良性非结石性疾病3例，恶性肿瘤23例。梗阻性黄疸的病因为胆总管结石同时合并十二指肠乳头旁憩室患者共150例。单因素分析结果显示：十二指肠乳头旁憩室更常见于男性；随着年龄的增加，十二指肠乳头旁憩室的发病率逐渐升高。憩室组与非憩室组之间，ERCP插管成功率、ERCP相关并发症发生率的差异无统计学意义，而胆总管结石、恶性肿瘤发病率的差异具有统计学意义。憩室组胆总管结石最大直径常≥1 cm,非憩室组胆总管结石最大直径多<1 cm。应用二元Logistic回归分析，结果提示男性十二指肠乳头旁憩室发病率是女性的1.764倍(95%CI:1.109～2.804;P=0.016);年龄每增加1岁，十二指肠乳头旁憩室发病率增加3.6%(95%CI:1.019～1.053;P<0.01)。结论 1.十二指肠乳头旁憩室可能与胆总管结石等胆胰系统疾病的发生相关。2.十二指肠乳头旁憩室可能影响胆总管结石的最大直径，合并有十二指肠乳头旁憩室的胆总管结石患者，结石最大直径常≥1 cm。3.十二指肠乳头旁憩室的存在不会明显影响ERCP插管成功率和ERCP相关并发症的发生率。4.十二指肠乳头旁憩室的发病率可能与性别和年龄相关。十二指肠乳头旁憩室更常见于男性；随着年龄的增加，十二指肠乳头旁憩室的发病率逐渐升高。更多还原

【Abstract】 Objective Exploring whether duodenal diverticulum near the nipple affects the success rate of ERCP catheterization and the incidence of ERCP related complications; The relationship between peripapillary duodenal diverticulum and obstructive jaundice and the influencing factors of the incidence rate of peripapillary duodenal diverticulum. Methods A retrospective analysis was conducted on the data of patients who underwent ERCP diagnosis and treatment for obstructive jaundice at the First People’s Hospital of Shangqiu City from January 2019 to December 2020. The patients were screened according to inclusion and exclusion criteria, and were divided into diverticulum group and non diverticulum group based on the presence of duodenal papilla diverticulum. Statistically analyze whether there are differences in gender, age, success rate of ERCP catheterization, and incidence of ERCP related complications between the diverticulum group and the non diverticulum group, and whether there are differences in the etiology of obstructive jaundice between the two groups.Results 311 cases were screened out that met the inclusion criteria, including 160 cases in the diverticulum group and 151 cases in the non diverticulum group. Through surgery and pathological examination, 301 patients were able to determine the cause of obstructive jaundice, while 10 patients were unable to determine the cause of obstructive jaundice. Among the causes of obstructive jaundice, there were 275 cases of common bile duct stones, 3 cases of benign non stone diseases, and 23 cases of malignant tumors. The cause of obstructive jaundice was a total of 150 patients with common bile duct stones combined with duodenal diverticulum. The results of univariate analysis showed that duodenal diverticulum is more common in males; The incidence rate of peripapillary duodenal diverticulum increases with age. There was no significant difference in the success rate of ERCP intubation and the incidence of ERCP related complications between diverticulum group and non diverticulum group, but there was significant difference in the incidence of common bile duct stones and malignant tumors. The maximum diameter of common bile duct stones in the diverticulum group is often ≥1 cm, while in the non diverticulum group, the maximum diameter of common bile duct stones is often<1 cm. Using binary logistic regression analysis, the results showed that the incidence rate of peripapillary duodenal diverticulum in men was 1.764 times that in women(95% CI: 1.109～2.804; P=0.016); The incidence rate of peripapillary duodenal diverticulum increased by 3.6%(95%CI:1.019～1.053;P<0.01). Conclusion 1. Parapapillary diverticulum of the duodenum may be associated with the occurrence of biliary and pancreatic system diseases such as common bile duct stones. 2. Duodenal diverticulum may affect the maximum diameter of common bile duct stones. Patients with common bile duct stones complicated with duodenal diverticulum often have a maximum stone diameter of ≥1 cm. The presence of duodenal papilla diverticulum does not significantly affect the success rate of ERCP catheterization and the incidence of ERCP related complications. 4. The incidence rate of peripapillary duodenal diverticulum may be related to gender and age. Duodenal diverticulum is more common in males; The incidence rate of peripapillary duodenal diverticulum increases with age.更多还原