先天性胆胰管合流异常与胆囊癌的关联

The relationship between anomalous junction of pancreaticobiliary duct and gallbladder carcinoma in Chinese patients

目的 研讨胆胰管合流异常 (APBDJ)在国人胆囊癌中的发生率及其相关因素 ,并对APBDJ的经内镜逆行胰胆管造影术 (ERCP)诊断标准作初步探讨。方法 2 0 0 0年 4月至 2 0 0 1年 9月期间 ,1876例患者接受ERCP诊疗 ,其中 10 82例胆管及胰管均显影 ,在这组患者中确定胆囊癌及APB DJ病例。APBDJ的诊断标准是胆、胰管共同通道的长度超过 15mm或壶腹部括约肌收缩段位于胆胰汇合部远侧。根据胆、胰管汇合的形态将其分成 2种类型 :P B型为胰管汇入胆管 ,B P型为胆管汇入胰管。结果 本组共发现胆囊癌 5 4例 ,其中 7例并发APBDJ(男 3例 ,女 4例 ;P B型 6例 ,B P型 1例 ) ,共同通道的平均长度 2 1 0mm(范围 12～ 4 5mm) ,1例尚合并胆管囊肿 ;另有 3例存在APBDJ(1例有胆管囊状扩张 ,2例胆胰管正常 )。APBDJ总发生率为 0 9% (10 / 10 82 ) ,均不合并胆囊结石 ,其在胆囊癌患者中的发生率高 (P <0 0 0 1) ,发病年龄较小 (P =0 0 5 6 )。结论 (1)国人胆囊癌的发生与先天性胆胰管合流异常有非常密切的关联 ,尤其易发于P B型 ;(2 )APBDJ的ERCP诊断标准可包括胆胰管共同通道长度超过 15mm或壶腹括约肌收缩段位于胆胰汇合部远侧。

Objective To study the frequency of anomalou s pancreaticobiliary ductal junction(APBDJ) in Chinese patients with gallbladder c ancer and to clarify preliminarily the diagnostic criterion for APBDJ during end oscopic retrograde cholangio-pancreatography(ERCP).Methods Between April 2000 and September 2001, 1876 patients un derwent ERCP. Among them 1082 cases, both biliary and pancreatic ducts were opac ified, 54 of these patients with proven gallbladder carcinoma were identified. A PBDJ was defined by a common channel >15 mm in length or the contractile segment distal to the union of the biliary and pancreatic ducts. When common bile duct appeared to join the main pancreatic duct, it was denoted as B-P type. While th e main pancreatic duct appeared to join the common bile duct, it was denoted as P-B type.Results Fifty-four patients had been proven to have gallbladde r carcinoma histopathologically. Seven of them (men 3, women 4) had APBDJ (P-B union 6, B-P union 1). The mean (SD) common channel was 21 0 mm ±11 2 mm in length (range 12 mm to 45 mm), among them there was one case with associated ear ly cystic dilation of bile duct. Three other patients had APBDJ: one was associ ated with a choledochal cyst and two with normal biliary trees. The overall prev alence of APBDJ was 0 9% (10/1082 cases). The incidence of APBDJ was significan tly higher in patients with gallbladder carcinoma (P<0 001). Those with APB DJ were significantly younger (p=0 056) and did not have associated gallstone.Conclusion (1)APBDJ is strongly associated with gallbladder can cer among Chinese patients,especially those with P-B subtype.(2) The ERCP diag nosis for APBDJ should include two items: common channel longer than 15 mm and t he contractile sphincter segment distal to the P-B union.