| Background:Bile duct stone is a common biliary disease in surgery,and a certain amount of bile duct stone patients can have Periampullary diverticulum(PAD)at the same time.There are many hypotheses about the pathogenesis of bile duct stone.Studies have suggested that the pathogenesis of bile duct stones may be related to factors such as diet,gender,age,body mass index,bile duct diameter,biliary tract infection,gallbladder status,and combined with PAD.It has been reported in the literature that patients with PAD are more likely to have bile duct stones,and the bile duct stones found in patients with PAD are mainly pigment stones.However,this view still lacks data support of accurate stone component analysis.The influence of PAD on bile duct stones and the internal mechanisms are yet to be explored.Research objective:to explore the impact of PAD on the components of bile duct stones,in order to provide new ideas for future researches on the pathogenesis,risk factors and prognosis of bile duct stones.Research method:This study is a case-control study.The subjects of the study were patients with choledocholithiasis who underwent ERCP at the Department of Special Minimally Invasive Surgery Department of the First affiliated Hospital of Lanzhou University from October 2019 to April 2020 and met the inclusion and exclusion criteria.The operator decided whether the patient had a periampullary diverticulum under direct vision during ERCP operation.After removing the stone using a stone-removing basket or a balloon,the retrieved stone sample was qualitatively analyzed by infrared spectroscopy technique,and then the cholesterol and the bilirubin components of the stone sample was quantitatively analyzed by spectrophotometric method.Spss23.0 was used to do statistical analyses.The measurement data of normal distribution was presented by (?)±s,and the independent sample nonparametric rank sum test was used for comparison between groups.The absolute value was used to present count data,and the x~2 test was used for inter group comparison.Logistic regression analysis was used to predict the influencing factors of stone composition,and the results were presented by 95%CI or value.P<0.05 was considered statistically significant.Research results:A total of 123 patients were recruited and 79 cases were excluded.A total of 44 patients were included in the study,including 22 males(50%)and 22 females(50%),with an average age of 60.9±16.7 years.Among them,14 cases(31.8%)were diagnosed as PAD under endoscope and were defined as the PAD group.The remaining 30 cases(68.2%)were defined as the non-PAD group.Comparison between PAD group and non-PAD group:age(67.2±14.0 years vs 58.0±17.0 years,P=0.091),bile duct diameter(16.43±5.80mm vs 15.17±3.81mm,P=0.407),calculus diameter(12.79±5.86)mm vs 12.77±4.97mm,P=0.620),TBIL(39.92±39.46U/L vs40.31±40.63U/L,P=0.605),AST(105.29±206.17U/L vs 135.33±274.98U/L,P=0.762),ALT(110.79±190.15U/L vs 138.8±185.43U/L,P=0.623),ALP(204.16±128.54U/L vs 201.04±184.92U/L,P=0.262),cholesterol content(39.77%±0.13 vs 61.8%±0.26,P=0.003),bilirubin content(27.03%±1.03 vs12.27%±0.16,P=0.003).There was no statistical difference in age,bile duct diameter,calculus diameter,TBIL,AST,ALT,ALP and other data between the two groups(P>0.05).There were statistical differences in the cholesterol composition and bilirubin composition of the stones between the two groups,and multivariate logistic regression analysis of cholesterol content showed that there were significant differences in PAD(P=0.021,OR=0.04,95%CI:0.003-0.611)and stone diameter(P=0.024,OR=13.250,95%CI:1.405-124.917)between the two groups.(P<0.05)Research conclusions:Compared with bile duct stone patients without PAD,patients with PAD have a higher level of bilirubin and a lower level of cholesterol in the stones.Combined periampullary diverticulum and stone diameter less than 15mm are independent influencing factors for the decrease of cholesterol content in bile duct stones. |
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