A Single Center Retrospective Study-Effect Of Duodenal Diverticulum On The Incidence Of Cholelithiasis

Objective To explore the effect of duodenal diverticulum on the incidence and recurrence of cholelithiasis by observing cases of cholelithiasis with duodenal diverticulum.Methods A total of 608 patients who underwent ERCP examination in Affiliated Hospital of Qingdao University from January 2013 to December 2015 were retrospectively analyzed.There were 173 patients with duodenal diverticulum in 608 cases,and 435 patients without duodenal diverticulum.There were 158 cases of choledocholithiasis and 72 cases of duodenal diverticulum.52 cases of cholecystolithiasis and 23 cases of duodenal diverticulum were combined.There were 23 cases of intrahepatic bile duct stones and 2 cases of duodenal diverticulum.There were 131 cases of gallbladder combined with choledocholithiasis and 61 cases of duodenal diverticulum.There were 17 cases of intrahepatic bile duct combined with choledocholithiasis and 6 cases of duodenal diverticulum.There were 16 cases of gallbladder and intrahepatic bile duct combined with choledocholithiasis and 2 cases of duodenal diverticulum.Group no gallbladder excision of common bile duct stones,gallbladder merge bravery to the gallbladder stone group.The choledocholithiasis after cholecystectomy and intrahepatic bile duct combined with choledocholithiasis were grouped into hepatolithiasis.There were 211 cases without stone and 7 cases with duodenal diverticulum.381 cases of duodenal diverticulum with calculi,follow up to December 2016,gall bladder calculi patients with duodenal diverticulum recurrence in 5 cases,26 patients with gallbladder stones with duodenal diverticulum recurrence and hepatic duct 3 cases of patients with duodenal diverticulum recurrence,1 case of patients with hepatic duct with duodenal diverticulum recurrence.According to the position of duodenal papilla and duodenal diverticulum,duodenal diverticulum was divided into duodenal diverticulum and duodenal diverticulum;according to the diameter of duodenal diverticulum,duodenal diverticulum was divided into large diverticulum(diameter≥1.5cm)and small diverticulum(diameter <1.5cm).There were 66 cases of gallstone patients with duodenal papilla with a diameter greater than 1.5cm.There were 22 cases of gallstone patients with duodenal papilla with a diameter smaller than 1.5cm.There were 44 cases of gallstone patients with diverticulum of the duodenal nipple with a diameter greater than 1.5cm..There were 24 cases of gallstone patients with diverticulum of the duodenal nipple with a diameter smaller than 1.5cm.There were 4 cases of hepatolithiasis with duodenal papilla with a diameter greater than 1.5cm.There were 1 case of hepatolithiasis with duodenal papilla with a diameter smaller than 1.5cm.There were 2 cases of hepatolithiasis with diverticulum of the duodenal nipple with a diameter greater than 1.5cm.There were 1 case of hepatolithiasis with diverticulum of the duodenal nipple with a diameter smaller than 1.5cm.The relationship between the incidence and recurrence rate of duodenal diverticulum in each group was analyzed.Logistic regression was used to analyze its correlation.Results(1)The p values of gallstones and hepatolithiasis were all < 0.05.It is indicated that the presence of duodenal diverticulum is statistically significant.Its OR value and the 95% confidence interval of OR are all > 1,indicating that the duodenal diverticulum has a positive correlation with the occurrence of calculi,and duodenal diverticulum can increase the incidence of calculi.The p value of gallbladder combined with hepatolithiasis was > 0.05,indicating that the duodenal diverticulum was not statistically significant,and the duodenal diverticulum did not increase the incidence of gallbladder combined with hepatolithiasis.(2)Recurrence of gallbladder stones p < 0.05,there is a statistical significance between the recurrence of duodenal diverticulum and gallbladder stones.The OR and its 95% confidence interval were greater than 1,can think of duodenal diverticulum and common bile duct calculi recurrence that there was a positive correlation between the duodenal diverticulum may cause a recurrence of gallbladder stones.However,there was no statistical significance in the recurrence of hepatolithiasis in patients with recurrence of hepatolithiasis and the recurrence of hepatolithiasis.That is,duodenal diverticulum was not the cause of recurrence of hepatolithiasis.(3)Duodenal diverticulum with different location of calculi after the analysis of p values > 0.05,no statistical significance,can be thought of as the location of the duodenal diverticulum for calculi incidence throughout all had no obvious effect;The diameters of the duodenal diverticulum with different location analysis of visible gallbladder stones group(p < 0.05,and the OR and its 95% confidence interval were greater than 1,can be thought of as the size of the duodenal diverticulum has an effect in the pathogenesis of gallbladder stone,and the increment of calculi incidence with duodenal diverticulum.Conclusion Patients with duodenal diverticulum are more likely to have gallbladder stones and hepatolithiasis.Patients with duodenal diverticulum have more recurrent gallbladder stones.The location of duodenal diverticulum has no obvious influence on the occurrence of calculi.The size of duodenal diverticulum is more likely to affect the occurrence of gallbladder stones,and the larger the diverticulum,the more likely it is to occur.