异常胰胆管连接与胰胆系病变的临床与实验对照研究

ANOMALOUS PANCREATICOBILIARY DUCTAL UNION AND DISORDERS:CLINICAL AND EXPERIMENTAL STUDY

为探讨异常胰胆管连接（ＡＰＢＤＵ）在胰胆系病变病因学中的作用及其发病机制，分析比较了７９例ＡＰＢＤＵ和５９例正常胰胆管连接患者的临床和经内镜逆行胰胆管造影结果；并用２６只犬分三组建立动物模型，于术后第５～１２０天检测血清淀粉酶、磷脂酶Ａ２活性和甘胆酸含量，第９０～２７０天作胰胆管造影和病理学检查。结果：胆管炎、胆管囊肿、胆系癌和慢性胰腺炎在ＡＰＢＤＵ组的发生率显著增高。实验研究也在多数犬复制出上述病变。结果提示ＡＰＢＤＵ对多种胰胆系病变有明确的致病作用，其致病机制是胆汁与胰液混流后，激活胰酶，从而引起胰胆管上皮损害。建议对于反复并发胰胆系病变的ＡＰＢＤＵ患者。

The objective of this study was to elucidate the connection of pancreaticobiliary disorders with anomalous ductal union. Clinical records and ERCP features of 79 patients with anomalous pancreaticobiliary ductal union (APBDU, group A) were analysed and compared with that of 59 cases with normal ductal union (group N).An experimental model of APBDU was established by anastomosis in 26 dogs. Post operatively phospholipase A 2 and amylase were determined on day 5～120; X ray images and pathology of models checked on day 90～270. As a result, the incidence of clinical cholangitis, pancreatitis, choledocholithiasis, choledochocyst and biliary cancer was statistically higher in group A than group N. Most pathologic changes above mentioned were discovered in canine models. It is considered that abnormal union of bile and pancreatic ducts plays an essential role in inducing pancreaticobiliary disorders. Reconstruction between the ducts seems mandatory in treating patients with APBDU and repeated attacks.