胆总管囊肿合并胰腺炎的研究

Choledochal Cysts and Pancreatitis

目的：了解胆总管囊肿、胰胆管异常合流（ＡＪＰＢＤ）与胰腺炎的关系。方法：对２５例胆总管囊肿患儿进行术中胆道造影、胰腺组织学、超微结构检查以及血清、胆汁淀粉酶测定。结果：造影证实有ＡＪＰＢＤ者１４例。光镜下５例胰腺有慢性炎细胞浸润和纤维组织增生，其中４例有Ａ－ＪＰＢＤ。电镜观察无ＡＪＰＢＤ的２例胰腺组织基本正常，有ＡＪＰＢＤ的６例（包括光镜观察正常者）的胰腺组织超微结构均有不同程度的改变，且随年龄增长而加重。ＡＪＰＢＤ组血清和胆汁淀粉酶均高于无ＡＪＰＢＤ组（Ｐ＜０．０５）。结论：胆总管囊肿、ＡＪＰＢＤ与胰腺炎有密切关系。ＡＪＰＢＤ引起的胰腺炎是一个慢性发展过程，经过电镜改变发展到光镜下改变。

Objective: To understand the relationship between choledochal cysts, anomalous pancreaticobiliary duct junction (APBDJ) and pancreatitis. Methods: Intraoperative cholangiogram, pancreatic histology and ultrastructure examination, serum and bile amylase measurements were carried out on 25 children with choledochal cysts. Results: Intraoperative cholangiogram revealed APBDJ in 14 patients. Five patients out of the total 25 had microscopic evidence of chronic pancreatitis, cells infiltration and fibrosis. Four of them had APBDJ. Electromicroscopic examination of 2 pancreatic specimens from children without APBDJ did not reveal any abnormality. All specimens from children with APBDJ (including those with normal light microscopic examination) showed various degrees of ultrastructural change, which became more prominent as the children became older. Serum and bile amylase levels in the APBDJ group were higher than those in the nonAPBDJ group (P<0.05). Conclusions: Choledochal cysts and APBDJ are closely associated with pancreatitis. The pancreatitis caused by APBDJ evolves slowly, going through ultrastructural stage, microscopic stage and finally macroscopic stage.