Diagnosis and clinical implications of pancreatobiliary reflux

Oddi 的括约肌在远侧的结束被定位胰腺并且胆汁管并且调整胆汁和胰液的流出。一条普通隧道能那么长连接胰腺并且胆汁管在十二指肠的墙外面被定位，，发生在 pancreaticobiliary maljunction (PBM ) ；在如此的情况中，括约肌行动机能上地不影响连接。因为在胰腺的管以内的水疗院压力通常比在胆汁管大，胰液经常倒流进在 PBM 的胆汁的管(pancreatobiliary 倒流) ，导致致癌物在胆道的非位的条件。Pancreatobiliary 倒流能经由次要的十二指肠的乳头状的小突起在胆汁，刺激分泌素的动态磁性的回声 cholangiopancreatography，和 pancreatography 从提高的淀粉酶水平被诊断。最近，没有 PBM， pancreatobiliary 倒流能发生在个人，变得明显。没有 PBM， Pancreatobiliary 倒流可能甚至在一些个人与胆汁的致癌作用有关。因为很少全身的研究与正常 pancreaticobiliary 连接在个人关于 pancreatobiliary 倒流的临床的关联和含意存在，包括适当管理的进一步未来的临床的研究应该被执行。

The sphincter of Oddi is located at the distal end of the pancreatic and bile ducts and regulates the outflow of bile and pancreatic juice. A common channel can be so long that the junction of the pancreatic and bile ducts is located outside of the duodenal wall, as occurs in pancreaticobiliary maljunction （PBM）; in such cases, sphincter action does not functionally affect the junction. As the hydropressure within the pancreatic duct is usually greater than in the bile duct, pancreatic juice frequently refluxes into the biliary duct （pancreatobiliary reflux） in PBM, resulting in carcinogenetic conditions in the biliary tract. Pancreatobiliary reflux can be diagnosed from elevated amylase level in the bile, secretinstimulated dynamic magnetic resonance cholangiop ancreatography, and pancreatography via the minor duodenal papilla. Recently, it has become obvious that pancreatobiliary reflux can occur in individuals without PBM. Pancreatobiliary reflux might be related to biliary carcinogenesis even in some individuals without PBM. Since few systemic studies exist with respect to clinical relevance and implications of the pancreatobiliary reflux in individuals with normal pancreaticobiliary junction, further prospective clinical studies including appropriate management should be performed.