ERCP In The Treatment Of Duodenal Diverticulum With Cholelithiasis

Objective:To explore the Endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of duodenal diverticulum merge cholelith disease curative effect analysis,can provide a reference basis for improving the clinical curative effect.Methods:retrospective analysis method is applied to collect in January 2010-December 2017 in yanbian university hospital to do endoscopic retrograde pancreatic angiography joint nipple sphincterotomy(EST)in patients with a total of 603 cases.Among them,182 patients with duodenal diverticulum complicated with cholelithiasis and 267 patients without diverticular cholelithiasis were selected between the ages of 30 and 89 for comparative analysis.1.The age,gender and composition of different nationalities of the two groups of patients were statistically analyzed.2.The anatomical position,number and diameter of duodenal diverticulum and nipple were statistically analyzed.3.The postoperative complications of patients with diverticulum complicated with cholelithiasis and those without diverticular cholelithiasis were statistically analyzed.4.Statistical analysis of the failure rate and failure reasons of ERCP in the diverticulum combined with chtherapeutic olelithiasis group and the non-diverticular cholelithiasis group.5.The observation results of diverticulum combined with cholelithiasis group and non-diverticular cholelithiasis group were statistically analyzed.Results:1.From January 2010 to December 2017,a total of 603 patients underwent ERCP combined EST in the affiliated hospital of yanbian university,and a total of 223 patients were diagnosed as duodenal diverticulum during the operation.Among them,182 patients in the duodenal diverticulum combined with cholelithiasis group and 267 patients in the non-diverticular cholelithiasis group.2.Age choose in this study two groups of patients between the ages of 30-89,diverticulum with cholelith disease group’s average age was 67.5 years old,no diverticulum cholelith disease group at an average age of 61.8 years,two groups of high-risk age distribution between the ages of 60-79,develops in elderly.Duodenal diverticulum is often distributed in elderly patients.3.There were 105 males(57.69%)and 77 females(42.31%)in the diverticulum group with cholelithiasis.A high proportion of diverticula patients with cholelithiasis are males.There were 137 male patients(51.31%)and 130 female patients(48.69%)in the non-diverticular cholelithiasis group.4.Among the diverticulum group with cholelithiasis,98 Korean(53.84%)had the highest proportion,followed by 80 han(43.96%)and 4 manchu(2.20%).113 Korean(42.32%),145 han(54.31%)and 9 manchu(3.37%)in the non-diverticular cholelithiasis group.5.182 patients with duodenal diverticulum included 163 cases with single diverticulum(89.56%)and 19 cases with multiple diverticulum(10.44%).According to the anatomical location of diverticulum and nipple,162 cases(89.01%)of diverticulum marginal nipple and 20 cases(10.99%)of diverticulum inner nipple were classified.Diverticulum edge nipple again by its diverticulum area can be divided into the upper left 58 cases(35.80%),upper right nipple type 40 cases(24.69%),next to the nipple(around)in 16 cases(9.88%),41 cases(25.31%)above the nipple type,type drop of 6 cases(3.70%),below the nipple type 1 case(0.62%).The diverticulum was divided into 22 cases of giant type(12.09%)by diameter,12 cases of deep type(6.59%),12 cases with diameter ranging from 1.0cm to 2.0cm(6.59%),and 136 cases with diameter less than or less than 1.0cm(74.73%).6.In the diverticulum group with cholelithiasis,postoperative pancreatitis occurred in 27 cases(14.80%),hemorrhage in 4 cases(2.20%)and biliary tract infection in 4 cases(2.20%).Eighteen cases(6.70%)of pancreatitis,four cases(1.50%)of hemorrhage and two cases(0.70%)of biliary tract infection occurred in the group without diverticular cholelithiasis.There was a statistically significant difference between the two groups(P<0.05).7.In the group of diverticulum complicated with cholelithiasis,the operation failed in 18 cases.In the group of cholelithiasis without diverticulum,13 cases were failed.The difference between the two groups was statistically significant(P<0.05).Diverticulum could affect the procedure of operation.8.In the group of diverticulum complicated with cholelithiasis,the results of ERCP were as follows:141 cases were cured,37 cases were improved and 20.30%,4 cases were not recovered.In the group without diverticulum cholelithiasis,233 cases were cured and 87.30 cases were cured,29 cases improved 10.90 cases,and 5 cases did not recover 1.90%.The difference between the two groups was statistically significant(P<0.05).Conclusion:1.ERCP is the most reliable method for the diagnosis of duodenal diverticulum.2.Patients with duodenal diverticulum complicated with cholelithiasis have a high requirement for the operation of ERCP.Determining the anatomical location of the papilla and diverticulum and inserting the bile duct quickly is the key to the success of the operation and can avoid complications such as perforation.3.ERCP is a safe,reliable and effective lithotomy for duodenal diverticulum complicated with cholelithiasis.