胆胰结合部——外科“遗忘”的角落

Biliary-pancreatic-duodenal junction:the forgotten corner of present day surgery

胆管、胰管与十二指肠的结合部,是人体内精微的结构,它受解剖学构型、括约肌功能、内分泌调控、神经支配的共同的、和谐的调节。胆-胰-肠结合部疾病可表现为梗阻或括约肌关闭不全。当前最常用的处理方法是内镜下乳头切开术或球囊扩张术。外科的努力重造新的有功能的结合部已有近百年历史,但距离目标仍然很远。

Junction of the bile duct and the pancreatic duct to the duodenum is a delicate construction in the human body. It is regulated by the combined harmonic action of anatomical configuration, sphincteric action as well as the hormonal regulation and nervous control. Diseases in the location may either be manifested as obstruction or as insufficiency of the sphincter function. Endoscopic manipulation such as sphincterotomy or balloonic dilatation of the sphincter is still the most frequently employed procedure. Surgery in attempt to reconstruct a new and functionally competent junction has been carried on for nearly a century, but still far from success.