BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with...BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies. DATA SOURCES: English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analysis. Data were extracted independently by two reviewers using a predefined spreadsheet. RESULTS: The incidence of PBM was higher in GBC patients than in controls (10.60% vs 1.76%, OR: 7.41, 95% CI: 5.03 to 10.87, P<0.00001). The proportion of female patients with PBM was 1.96-fold higher than in GBC patients without PBM (80.5% vs 62.9%, OR: 1.96, 95% CI: 1.09 to 3.52, P=0.12). GBC patients with PBM were 10 years younger than those without PBM (SMD: -9.90, 95% CI: -11.70 to -8.10, P<0.00001). And a difference in the incidence of associated gallstone was found between GBC patients with and without PBM (10.8% vs 54.3% OR: 0.09, 95% CI: 0.05 to 0.17, P<0.00001). Among the GBC patients with PBM, associated congenital dilatation of the common bile duct was present with a higher incidence ranging from 52.2% to 85.7%, and 70.0%-85.7% of them belonged to the P-C type of PBM (the main pancreatic duct enters the common bile duct). No substantial heterogeneity was found and no evidence of publication bias was observed.CONCLUSIONS: PBM is a high-risk factor for developing GBC, especially the P-C type of PBM without congenital dilatation of the common bile duct. To prevent GBC, laparoscopic cholecystectomy is highly recommended for PBM patients without congenital dilatation of the common bile duct, especially relatively young female patients without gallstones.展开更多
对3例先天性胆管扩张症合并胆管结石,利用 X 线衍射仪及红外线吸收光谱仪检测结石样品,发现3例结石成分基本一致,结晶程度极好,晶态物质的主要成分为柠檬酸钙、硬脂酸钙。结石属特殊型结石。作者认为,结石成因可能与胰胆管合流异常、胰...对3例先天性胆管扩张症合并胆管结石,利用 X 线衍射仪及红外线吸收光谱仪检测结石样品,发现3例结石成分基本一致,结晶程度极好,晶态物质的主要成分为柠檬酸钙、硬脂酸钙。结石属特殊型结石。作者认为,结石成因可能与胰胆管合流异常、胰液返流、胰脂肪酶被激活有关。同时对比观察2例遗传性球形细胞增多症合并胆囊结石的成分、类型与前者不同。指出胰胆管合流异常、胰液返流在结石形成过程中的作用值得重视。展开更多
文摘目的:探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)在诊断和治疗小儿胰胆管汇合异常(pancreaticobiliary maljunction, PBM)中的安全性和有效性。方法:回顾性分析本院ERCP确诊为PBM的74例患儿,分析临床资料和术后随访。结果 :按照日本胆胰管合流异常研究组(Japanese Study Group on Pancreaticobiliary Maljunction, JSGPM)分型,A型32例,B型16例,C型23例,D型3例。MRCP检查的阳性诊断率仅8%。本研究所有患儿均行乳头肌切开和鼻胆管引流。其中69例(93.4%)行取石/蛋白酶栓,2例术后留置胰管支架。7例(9.5%)术后出现ERCP后轻型胰腺炎,无术后出血、贲门撕裂及穿孔等严重并发症发生。除7例(9.5%)PBM不合并胆道扩张的患儿外,其余术后均行肝外胆管切除+肝管空肠Roux-en-Y吻合术。结论:ERCP在小儿PBM的诊治过程中具有诊断效力强、疗效好、安全性高的优点,对早期确诊并干预PBM的病理进程具有重要意义。
文摘BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies. DATA SOURCES: English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analysis. Data were extracted independently by two reviewers using a predefined spreadsheet. RESULTS: The incidence of PBM was higher in GBC patients than in controls (10.60% vs 1.76%, OR: 7.41, 95% CI: 5.03 to 10.87, P<0.00001). The proportion of female patients with PBM was 1.96-fold higher than in GBC patients without PBM (80.5% vs 62.9%, OR: 1.96, 95% CI: 1.09 to 3.52, P=0.12). GBC patients with PBM were 10 years younger than those without PBM (SMD: -9.90, 95% CI: -11.70 to -8.10, P<0.00001). And a difference in the incidence of associated gallstone was found between GBC patients with and without PBM (10.8% vs 54.3% OR: 0.09, 95% CI: 0.05 to 0.17, P<0.00001). Among the GBC patients with PBM, associated congenital dilatation of the common bile duct was present with a higher incidence ranging from 52.2% to 85.7%, and 70.0%-85.7% of them belonged to the P-C type of PBM (the main pancreatic duct enters the common bile duct). No substantial heterogeneity was found and no evidence of publication bias was observed.CONCLUSIONS: PBM is a high-risk factor for developing GBC, especially the P-C type of PBM without congenital dilatation of the common bile duct. To prevent GBC, laparoscopic cholecystectomy is highly recommended for PBM patients without congenital dilatation of the common bile duct, especially relatively young female patients without gallstones.
文摘对3例先天性胆管扩张症合并胆管结石,利用 X 线衍射仪及红外线吸收光谱仪检测结石样品,发现3例结石成分基本一致,结晶程度极好,晶态物质的主要成分为柠檬酸钙、硬脂酸钙。结石属特殊型结石。作者认为,结石成因可能与胰胆管合流异常、胰液返流、胰脂肪酶被激活有关。同时对比观察2例遗传性球形细胞增多症合并胆囊结石的成分、类型与前者不同。指出胰胆管合流异常、胰液返流在结石形成过程中的作用值得重视。
