Biliary Manometry In Common Bile Duct Stones Patients With Juxta-papilary Duodenal Diverticulum

Background and ObjectiveJuxta-papilary duodenal diverticulum is so common in the clinical illness. With the popularization and development of the technology of endoscopic retrograde cholangiopancreatography, the detection rate of JPD is higher than old days. Currently, domestic and foreign scholars have reached a consensus on the effects of common bile duct stone formation and thought JPD as a key factor. For patients with common bile duct stone in combination with JPD, it is very important to use appropriate endoscopic sphincteropapillotomy technology to reduce the complications and recurrence of stones after endoscopy.Biliary pressure is mainly maintained by the liver cell secreted pressure, Sphincter of Oddi’s tension and comprehensive factors such as respiratory movement, and it is an important indicator for bile duct surgery. While in patients with abnormal Oddi sphincter function, biliary manometry is the gold standard for diagnosis and treatment evaluation. SO is composed of common bile duct sphincter, pancreatic sphincter and Vater’s ampulla sphincter, all of the three part play a two-way regulating functions together in the regulation and control of the excretion of bile and pancreatic juice to intestinal tract, and also control intestinal juice regurgitation.At present, the main research direction of biliary manometry is mainly on the sphincter of Oddi dysfunction. While it is not yet reported that JPD quantitative impact on bile duct pressure, especially no unified objective standards as a basis for guiding clinical operation and evaluation of clinical curative. This study based on the biliary manometry of different types common bile duct stone patients with duodenal papilla diverticulum.Through the comparison of biliary pressure to observer the regular pattern before and after the EST therapy. Also we hope to evaluate the therapeutic value of EST. study the incidence of complications after EST. In additional, we apply traditional Chinese medicine in the study to improve clinical symptoms.Materials and Methods 97common bile duct stone patients with52cases of juxta-papilary duodenal diverticulum were divided into two groups. Experimental group:52common bile duct stone patients with juxta-papilary duodenal diverticulum were divided into two groups, including gallbladder stones with28patients and24cases after cholecystectomy. According to the process of intraoperative situation. EST was used to relief biliary pressure, and respectively operating biliary manometry before and after EST therapy. Except the45common bile duct stone patients were without juxta-papilary duodenal diverticulum. control group is similar to experimental group. After biliary manometry and ERCP therapy,97patients were randomly divided into traditional Chinese medicine control group and experimental group again. Through the comparison of bile flow, liver function to evalute the clinical value of traditional Chinese medicine.(1)Observe experimental group and control group patients’ clinical dates.(2)Recording materials about patients’ biliary pressure changes before and after EST. and also operating biliary manometry again one month after EST therapy.(3)Recording materials about bilious flow and liver function changes after using traditional Chinese medicine.(4)Take notes of complication and discharged situation after relevant operation.Results1、biliary manometry between control group and experimental group Statistical analysis shows that biliary pressure of common bile duct stone patients with JPD is much higher than those without JPD.2、biliary pressure before and after EST Respectively operating biliary manometry between common bile duct stones patients with gallbladder stones and after cholecystectomy. By statistical analysis, we discover that biliary pressure of these patients were all declined after EST therapy. And also after EST therapy, biliary pressure of patients with JPD is still higher than patients without JPD.3、biliary manometry between common bile duct stones patients with gallstones and after cholecystectomy Statistical analysis shows that biliary pressure of patients after cholecystectomy is much higher than patients with gallstones.4、The incidence of complications and discharged situation3cases hyperamylasemia,2cases acute pancreatitis and2cases mild cholangitis postoperative, all the patients return to normal after non-operative treatment. The incidence of complications was7.22%(7/97). No serious complications. No longer time in hospital.5、Evaluate the use of traditional Chinese medicine in the treatment of common bile duct stone Statistical analysis shows that patients’ liver function and other indicators improved more quickly in experimental group than control group with the use of traditional Chinese medicine.6、Follow-up recurrence of symptomsWe carried on biliary manometry in81patients after one month and found that experimental group’s biliary pressure is higher than control group. And statistical analysis shows that patients with JPD have a higher incidence of relevant clinic symptoms than those without JPD after the end of follow-up of.Conclusion1、The study found that biliary pressure in experimental group is relatively higher than control group. Clearly show the theory that the presence of juxta-papilary duodenal diverticulum changed common bile duct pressure and sphincter of Oddi pressure, thereby promote gallstone formation.2、With the use of EST technology, we can alleviate patients biliary pressure, improve the biliary emptying dysfunction and reduce the incidence of stones recurrence. No matter before and after EST therapy, the biliary of patients with JPD is higher than those without JPD. maybe concerned with the fact that JPD can effect biliary dyskinesia.3、Study found that the biliary pressure of patients after cholecystectomy is much higher than common bile duct patients with gallstones, which maybe associated with the gallbladder normal contraction function. Gallbladder and sphincter of Oddi both are very important to maintain biliary pressure.4、The use of biliary manometry in ERCP treatment will not increase the risk of complications and discharged time.5、The application of traditional Chinese medicine in the common bile duct stone patients can accelerate liver function and other indicators returned to normal.