The relationship between juxtapapillary duodenal diverticula and the presence of bacteria in the bile.

N Shinagawa, T Fukui, K Mashita, Y Kitano, J Yura
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引用次数: 6

Abstract

A total of 432 patients with gallstone disease were studied with respect to the existence of juxtapapillary duodenal diverticula and their relationship to the presence of bacteria in the bile. A total of 63 patients were found to have diverticula with an incidence of 14.6 per cent, being significantly higher in the elderly group aged 60 years or older (p less than 0.01), and no sex difference was noted. Among the patients with diverticula, positive bacterial cultures of bile were recognized at a significantly higher frequency, being found in 49 of the 63 patients (77.8 per cent; p less than 0.01), and the probability of bilirubinate stones was also higher, being found in 35 of 37 patients (94.6 per cent; p less than 0.01). The presence of a diverticulum bore significant relation to a higher positive bile bacterial culture (p less than 0.05), dilation of the common bile duct (p less than 0.05), and elevation of the bile duct pressure (p less than 0.05), even when the conditions were divided into cholecystolithiasis or choledocholithiasis. It was suggested that the presence of a diverticulum affected the flow in the bile duct by narrowing it from the outside and chronically stimulating the papilla, inducing biliary tract infection and/or the formation of gallstones. As the surgical procedures for juxtapapillary duodenal diverticula, including its indications, have not been established, long term follow up investigations seem necessary.

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十二指肠乳头旁憩室与胆汁细菌存在的关系。
本文研究了432例胆结石患者乳头旁十二指肠憩室的存在及其与胆汁中细菌存在的关系。共发现憩室63例,发病率14.6%,60岁及以上年龄组发病率明显高于老年组(p < 0.01),性别差异无统计学意义。在憩室患者中,胆汁细菌培养阳性的频率明显更高,63例患者中有49例(77.8%;P < 0.01),胆红素结石发生率也较高,37例患者中有35例出现胆红素结石(94.6%;P < 0.01)。憩室的存在与较高的胆汁细菌培养阳性(p < 0.05)、胆总管扩张(p < 0.05)和胆管压力升高(p < 0.05)有显著关系,即使当病情分为胆囊结石或胆总管结石时也是如此。提示憩室的存在通过从外部使胆管变窄,慢性刺激乳头,诱导胆道感染和/或胆结石的形成,从而影响胆管的流动。由于十二指肠乳头旁憩室的手术方法及其适应症尚未确定,因此有必要进行长期随访。
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