从胆胰肠结合部解剖谈胆源性胰腺炎发生与防治

Discussion on the occurrence, prevention and treatment of biliary pancreatitis via analyzing the anatomy of choledocho-pancreatico-duodenal junction

胆源性胰腺炎是我国急性胰腺炎的主要类型,始动因素是胆道疾病阻塞胆胰共同通道导致胆胰管同时梗阻,因此,胆胰肠结合部的解剖构型与胆源性胰腺炎的发生密切相关。胆胰管汇合方式可分为无合流、正常合流和异常合流(PBM)。无合流(U型)不会引起胆源性胰腺炎。正常合流中,V型可因结石压迫胰管引起胰管开口进行性水肿导致胆源性胰腺炎;短Y型易同时阻塞胆胰管导致胆源性胰腺炎;长Y型若结石小未堵塞胰管开口,胰液能流入胆管缓冲了胰管压力而不易导致胆源性胰腺炎。异常合流中,C-P型若结石排出时阻塞胰管或P-C型若结石长径过长阻塞胰管均将导致胆源性胰腺炎。因此,应依据胆胰肠结合部不同的解剖学分型防治胆源性胰腺炎,对于V型和短Y型病人应及时治疗胆道结石。由于缺乏大样本临床研究和精准的影像学评估,胆胰肠结合部的解剖与胆源性胰腺炎发生及防治的关系仍待进一步探究。

Biliary pancreatitis is the main type of acute pancreatitis in China.The initiating factor is the obstruction of both common bile duct and pancreatic duct caused by biliary tract diseases.Therefore,the anatomical configuration of choledocho-pancreatico-duodenal junction is closely related to the occurrence of biliary pancreatitis.The confluence types of biliopancreatic duct can be divided into no confluence,normal confluence and abnormal confluence(PBM).No confluence(U type)may not cause biliary pancreatitis.In normal confluence,V type may cause biliary pancreatitis through progressive edema of pancreatic duct opening orifice due to the compression of pancreatic duct by stones;Short-Y type is easy to cause biliary pancreatitis by blocking the biliopancreatic duct simultaneously;Long-Y type may not cause biliary pancreatitis owing to pancreatic juice flowing into the bile duct to decrease the pancreatic duct pressure if the pancreatic duct opening orifice is not obstructed by stone.In abnormal confluence,if the pancreatic duct of C-P type is obstructed when the stone is discharged,or if the length of the stone in P-C type is so long that obstruct the pancreatic duct,both conditions will lead to biliary pancreatitis.Therefore,the prevention and treatment of biliary pancreatitis should be based on the different anatomical types of cholodochopancreatico-duodenal junction.For patients with V type and short-Y type,biliary stones should be treated in time.However,due to the lack of large sample clinical research and accurate imaging evaluation,the relationship between the anatomy of choledocho-pancreatico-duodenal junction and the occurrence,prevention and treatment of biliary pancreatitis remains to be further explored.