中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (05): 357-359.

• 专题笔谈 • 上一篇    下一篇

胰胆结合部病变与胆囊癌

田伏洲，骆助林，张丙印，汤礼军，庞    勇，任建东   

  1. 成都军区总医院全军普外中心，四川成都610083
  • 出版日期:2010-05-01 发布日期:2010-05-06

  • Online:2010-05-01 Published:2010-05-06

PDF

912

摘要：

胰胆结合部先天性异常（APBD）病人胆囊癌的发生率高达50%以上，且发病年龄也较正常人群提前。成都军区总医院全军普外中心统计1995－2007年收集的有CC长度或可供测量的胰胆管影像学资料共694份，APBD病人胆囊癌发病率也高达21.8%。目前国内外诊断APBD多以共同通道（CC）长度≥15mm作为金标准，而CC长度<15mm的“正常人群”胆囊癌发病特点文献报告则很少。在上述12年694份胆胰管影像学资料的统计中，除28例APBD病人以外，本研究将正常人群也分为短CC组（<6mm）及长CC组（6～<15mm），发现后者的胆囊癌发病率较前者高10倍。随机取两组部分病人的胆汁查淀粉酶浓度，长CC组也明显高于短CC组。说明无论是APBD还是“正常人群”，只要胆胰结合部因长度或其他原因造成胰胆反流，均可使病人胆囊癌的发病率增加。因此测定病人CC长度并检测胆汁淀粉酶浓度，可能是预测胆囊癌发病风险的方法。

关键词: 胰胆反流, 胆囊癌, 胆胰管合流异常

Abstract:

Association of gallbladder carcinoma and anomalous pancreaticobiliary ductal junction  TIAN Fu-zhou, LUO Zhu-lin, ZHANG Bing-yin，et al. PLA General Surgery Center, Chengdu General Military Hospital, Chengdu 610083, China
Corresponding author: TIAN Fu-zhou, E-mail: tfz30061@yahoo.com.cn
Abstract    Incidence of gallbladder carcinoma in patient with anomalous pancreaticobiliary ductal junction （APBD）has been noted as high as 50% or more. The patients with APBD have an earlier age of onset comparing with the “normal people”. It found the similar result in 694 pancreaticobiliary ductal image materials admitted between 1995—2007 at PLA General Surgery Center of Chengdu General Military Hospital. Incidence of gallbladder carcinoma in patients with APBD was 21.8%. It is noteworthy that the length of common channel (CC) more than 15 mm is considered as the gold standard for the diagnosis of APBD in the world. The literature about characteristics of gallbladder carcinoma in “normal people” with the length of CC less than 15mm is rare. All the “normal people” were divided into short CC group and long CC group except for 28 patients with APBD in 694 pancreaticobiliary ductal image materials. Incidence of the latter was 10 times higher than that of the former. The concentration of amylase in bile in long CC group was higher than that in short CC group. The mechanism of the high incidence of gallbladder carcinoma may the reflux of the pancreatic juice into the bile duct. Measuring the length of CC and detecting the concentration of amylase in bile might be a method for predicting the onset risk of gallbladder carcinoma.

Key words: pancreaticobiliary reflux, gallbladder carcinoma, anomalous pancreaticobiliary ductal junction