The Relationship Between Duodenal Diverticulum And Biliary Tract Diseases And ERCP Intubation

Aim:Retrospective study of(Periampullary diverticula,PAD),the impact of biliary tract disease and Endoscopic retrograde cholangiopancreatography(ERCP)intubation,and the exploration of independent risk factors for recurrence of common bile duct stones.Methods:Retrospective investigation and research in recent 10 years in liver and gallbladder surgery line of endoscopic treatment of common bile duct calculi of 970 cases of patients with clinical manifestations and history,the material such as image data and report of diagnosis and treatment of ERCP,explore our liver and gallbladder surgery ERCP successful intubation,PAD of ERCP intubation presence of influence,and the PAD in the crowd incidence,any age,and gender bias.The number of successful and unsuccessful intubation cases was counted,and the success rate of ERCP intubation was calculated.According to the presence of PAD into the PAD and the PAD group,based on gender,age,primary or secondary stones,cholangitis,presence of pancreatitis,common bile duct diameter,diameter and number of the stone,whether or not successful intubation for single factor statistical analysis of the factors related to explore the epidemiology of PAD and the biliary tract diseases;According to the occurrence of recurrent choledocholithiasis 6 months after ERCP lithotomy,primary choledocholithiasis was divided into two groups: recurrence and non-recurrence.Univariate analysis was performed on gender,age(60 years old),history of biliary duct surgery,size and number of stones(2),PAD,cholangitis,common bile duct diameter,and ERCP frequency per hospitalization(2)to find out the influencing factors of recurrent choledocholithiasis.Then,statistical observations with P<0.05 were substituted into Logistic regression analysis to calculate P value,OR value,upper and lower limits of 95% confidence interval of OR and other statistical values,and the independent risk factors affecting the occurrence of recurrent choledoch stones were finally found out.Results:A total of 970 patients were included,of which 912 were successfully intubated,the success rate was 94%.The success rate of intubation was similar between the PAD group and the non-PAD group,also 94%,but P>0.05 after t test.The morbidity of PAD in male patients was 30.6%,compared with 22.1% in female patients,P<0.01;PAD was significantly correlated with the incidence of primary choledocholithiasis,cholangitis,and stone diameter >1.0cm(P<0.01),but not with pancreatitis,common bile duct diameter,and the number of common bile duct stones(P>05).Single factor analysis showed that the risk factors of primary common bile duct calculi recurrence with pancreatitis,biliary tract surgery,single line hospital ERCP number 2 OR more times,the maximum transverse diameter of common bile duct >1.5cm,the number of stones was more than 2,and the maximum transverse diameter of calculi>1.0cm(P<0.05),the calculi recurrence set as the dependent variable,the observation indexes set as independent variables.Logistic multiple regression analysis showed that bile duct inflammation,common bile duct diameter >1.5cm,biliary duct operation history,single hospitalization ERCP twice OR more were independent risk factors for stone recurrence(OR>1,OR 95%C.I.Lower limit >1 and P<0.05).Conclusion:PAD tends to occur in elderly patients without gender bias,and had no effect on ERCP successful bile duct intubation.PAD promoted the occurrence of primary choledocholithiasis,cholangitis,and stone diameter >1.0cm.Biliary inflammation,common bile duct diameter >1.5cm,history of biliary operation,single hospitalization of ERCP >2 were independent risk factors for recurrence of primary common bile duct stones.