摘要
Background/purpose For anomalous arrangement of the pancreaticobiliary duct (A APBD) with nondilatation of the common bile duct (CBD), the optimal surgical pro cedure remains controversial. The authors investigated which procedure would be most effective for AAPBD with nondilatation of the CBD. Methods The authors enco untered 60 children with AAPBD in our institution between 1979 and 2002.Six of the 60 were classified as the nondilated type (CBD diameter; less than 8 mm), wh ereas the other 54 were classified as the dilated type (CBD diameter; more than 9 mm). Amylase levels in serum, CBD, and gallbladder were examined. Cellular act ivity of the resected gallbladder was examined for the incidence of hyperplasia and Ki-67 labeling index (Ki-67 LI). Results The amylase level in the nondilat ed type was elevated as in the dilated type. Epithelial hyperplasia of the gallb ladder was present in 4 of the 6 with the nondilated type (67%). 10 of the 20 w ith the dilated type (50%), and none of the 6 controls (0%). The Ki-67 LI of the dilated type was significantly higher than that of control. Conclusions A fr ee reflux of pancreatic juice into the biliary system was found regardless of di latation, and cellular proliferative activity of the gallbladder mucosa was incr eased in both the nondilated and dilated type. Therefore, excision of the extrah epatic bile duct including cholecystectomy is recommended for AAPBD with nondila tation of the CBD.
Background/purpose For anomalous arrangement of the pancreaticobiliary duct (A APBD) with nondilatation of the common bile duct (CBD), the optimal surgical pro cedure remains controversial. The authors investigated which procedure would be most effective for AAPBD with nondilatation of the CBD. Methods The authors enco untered 60 children with AAPBD in our institution between 1979 and 2002.Six of the 60 were classified as the nondilated type (CBD diameter; less than 8 mm), wh ereas the other 54 were classified as the dilated type (CBD diameter; more than 9 mm). Amylase levels in serum, CBD, and gallbladder were examined. Cellular act ivity of the resected gallbladder was examined for the incidence of hyperplasia and Ki-67 labeling index (Ki-67 LI). Results The amylase level in the nondilat ed type was elevated as in the dilated type. Epithelial hyperplasia of the gallb ladder was present in 4 of the 6 with the nondilated type (67%). 10 of the 20 w ith the dilated type (50%), and none of the 6 controls (0%). The Ki-67 LI of the dilated type was significantly higher than that of control. Conclusions A fr ee reflux of pancreatic juice into the biliary system was found regardless of di latation, and cellular proliferative activity of the gallbladder mucosa was incr eased in both the nondilated and dilated type. Therefore, excision of the extrah epatic bile duct including cholecystectomy is recommended for AAPBD with nondila tation of the CBD.
