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81.
82.
To clarify the anatomy of the pancreatic duct system and to investigate its embryology, we reviewed 256 pancreatograms with normal pancreatic head, 81 with pancreas divisum and 74 with pancreaticobiliary maljunction. Accessory pancreatograms were divided into two patterns. The long-type accessory pancreatic duct forms a straight line and joins the main pancreatic duct at the neck portion of the pancreas. The short-type accessory pancreatic duct joins the main pancreatic duct near its first inferior branch. The short-type accessory pancreatic duct is less likely to have a long inferior branch arising from the accessory pancreatic duct. The length of the accessory pancreatic duct from the orifice to the first long inferior branch was similar in the short- and long-type accessory pancreatic ducts. The first long inferior branch from the long-type accessory pancreatic duct passes though the main pancreatic duct near the origin of the inferior branch from the main pancreatic duct. Immunohistochemically, in the short-type accessory pancreatic duct, the main pancreatic duct between the junction with the short-type accessory pancreatic duct and the neck portion was located in the ventral pancreas. The long-type accessory pancreatic duct represents a continuation of the main duct of the dorsal pancreatic bud. The short-type accessory pancreatic duct is probably formed by the proximal main duct of the dorsal pancreatic bud and its long inferior branch. 相似文献
83.
Yoshiaki Tanaka Chiaki Kawaguchi Hiroyoshi Mizote Hiromichi Yano 《Surgery today》1999,29(11):1168-1171
Duplication of the biliary tract is extremely rare. In fact, to the best of our knowledge, only four previous reports of pediatric
patients with this disease have been documented in the Japanese literature. This anomaly was diagnosed by perioperative endoscopic
retrograde cholangiopancreatography (ERCP) in three of these patients, and incidentally during surgery for congenital biliary
dilation in the other one. We report herein a case of biliary tract duplication which was diagnosed by T-tube cholangiography,
only in the oblique view, after cholecystectomy and choledochotomy with T-tube drainage. The patient was a 13-year-old girl
who was initially diagnosed as having choledocholithiasis based on the results of preoperative and intraoperative cholangiography;
however, a postoperative T-tube cholangiography revealed residual stones. At this point, duplication of the biliary tract
was diagnosed only in the first oblique view. Reoperation was carried out 26 days after the first operation. The biliary tract
was dissected completely from the pancreaticobiliary junction to the left and right hepatic ducts in the porta hepatis and
found to be duplicated from the level of porta hepatis to the suprapancreatic area. We report our experience of this case,
followed by a discussion on the relevant literature. 相似文献
84.
Hisami Ando Kenitiro Kaneko Fujio Ito Takahiko Seo Tohru Harada Yoshio Watanabe 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(1):50-54
The embryogenesis of pancreaticobiliary maljunction is inferred from the embryogenesis of duodenal atresia. The epithelial
cells of the duodenum begin to proliferate and completely plug the lumen, but a process of vacuolation recanalizes the duodenum.
Recanalization of the common duct frequently appears with two lumina and openings into the duodenum with two orifices. These
two major canals create a narrow segment of the duodenum and this narrow zone is the area in the duodenum that is most prone
to faulty recanalization and atresia formation. A bifid biliary system inserts at blind upper and lower pouches of the duodenum,
and the common bile duct inserts in a Y fashion. The common bile duct inserts at the stenotic segment, and the end result
is a T-shaped formation in patients with duodenal stenosis. During the development of the bile duct, abnormal fusion may occur
between the bile duct and branches of the right ventral pancreatic duct. The site in the bile duct where a branch of the pancreatic
duct joins is likely to develop atresia due to disturbance of the recanalization process, as seen in duodenal atresia. Severe
impairment of vacuolation causes divided atretic bile duct at the site where the pancreatic duct inserts in a Y-fashion into
the upper and lower bile duct. Moderate impairment of vacuolation causes a stenosis at the site where the pancreatic duct
inserts in a T-shape, with a moderate dilatation of the bile duct.
Received for publication on Oct. 21, 1998; accepted on Nov. 2, 1998 相似文献
85.
Jean-Jacques Tuech Patrick Pessaux Christophe Aube Nicolas Regenet Charles Cervi Roberto Bergamaschi Jean-Pierre Arnaud 《Journal of hepato-biliary-pancreatic sciences》2000,7(3):336-338
A rare case of pancreaticobiliary maljunction (PBM) without dilatation of the biliary tract (DBT) associated with gallbladder carcinoma is described herein. A 62‐year‐old European woman with a long history of right upper abdominal pain was diagnosed as having PBM without DBT by endoscopic retrograde cholangiopancreatography and other examinations. Excision of the gallbladder and biliary duct with a Roux‐en‐Y hepaticojejunostomy was performed, and subsequent pathological examination of the surgical specimen showed a well differentiated adenocarcinoma of the gallbladder. She had no clinical symptoms for 58 months postoperatively. PBM allows reflux of pancreatic juice into the biliary tract. Recent findings support the idea that epithelial hyperplasia plays an important role in gallbladder carcinogenesis with PBM, and also support the concept that gene mutations are involved in the carcinogenesis of biliary epithelium in patients with PBM. For these reasons, we advocate that resection of the extrahepatic biliary tract in PBM patients without bile duct dilatation, rather than cholecystectomy alone, is the treatment of choice for preventing bile duct carcinoma. 相似文献
86.
87.
目的 探讨壶腹周围疾病对内镜保胆取石手术疗效的影响。方法 回顾性分析2009年12月-2012年12月该科腹腔镜辅助内镜保胆取石术后再次入院治疗的24例伴有壶腹周围疾病患者的临床资料。结果 24例患者中Oddi括约肌功能障碍(SOD)胆型8例,SOD胰型2例,SOD混合型1例,以腹痛为主要表现。十二指肠乳头憩室5例,胆胰合流异常4例,十二指肠乳头炎3例,十二指肠乳头癌1例,其中6例表现为胆囊造瘘管拔除后经瘘道持续性胆汁外漏,5例表现为胆囊内胆泥淤积/泥沙样结石,2例表现为上腹部疼痛。10例SOD患者经解痉抑酸治疗后缓解,1例胆型SOD因药物治疗无效而采取十二指肠镜治疗后缓解;5例胆囊内胆泥淤积/泥沙样结石患者口服胆石利通片及牛磺熊去氧胆酸胶囊1个月以上无效;6例胆汁外漏患者采取局部瘘道缝合无效;5例十二指肠乳头憩室、4例胆胰合流异常、3例十二指肠乳头炎及1例十二指肠乳头癌患者采取十二指肠镜治疗后症状消失。结论 壶腹周围疾病是内镜保胆取石术胆囊造瘘管拔除后经瘘道持续性胆汁外漏,腹痛及胆囊结石复发的重要原因。 相似文献
88.
Hideki Fujii Jun Itakura Yoshiro Matsumoto 《Journal of Hepato-Biliary-Pancreatic Surgery》1996,3(4):423-430
We reviewed the data for 155 patients with congenital cystic dilatation of the common bile duct (CCDB; Alonso-Lej Type I)
treated at our institute in the past 12 years. Our definition of CCDB was segmental enlargement of the common bile duct or
enlargement involving the proximal bile duct, visualized on cholangiograms. CCDB was subclassified as infant or adult type
cyst, based on the extent of the enlargement and the clinicopathologic findings. The former is typically an enlargement of
the common bile duct or an enlargement involving the common hepatic duct, while the latter is an enlargement of the entirety
of the extrahepatic ducts or involves the intrahepatic bile ducts. Of the 155 patients, 5 (including 1 child) had infant type
cysts and 150 (including 1 child) had adult type cysts; 125 patients had benign CCDB (3 with infant type cyst) and 30 exhibited
CCDB biliary malignancy (2 with infant type). Anomalous arrangement of the pancreaticobiliary ductal system (AAPB) and congenital
biliary stricture were frequently associated with CCDB and these features played an important role in the presenting symptoms
of CCDB: AAPB was detected in 100 of the 155 patients, and stricture in 51. AAPB caused disturbance of the passage of bile
from the terminal bile duct to the duodenum and cholestasis in the enlargement, with reciprocal regurgitation of bile into
the pancreas and pancreatic juice into the bile duct, and the AAPB appeared to precede obstructive jaundice, acute pancreatitis,
or biliary malignancies. Stricture was observed at one to all of six sites in the hepatic hilum. Intrahepatic stones were
seen in 30 patients, and intrahepatic bile duct cancer was seen in 8 patients; in all these 8 patients, the cancer was associated
with primary intrahepatic stones. 相似文献
89.
胰胆管十二指肠连接区癌的CT诊断 总被引:1,自引:0,他引:1
日的 探讨胰ancreaticobiliary ductal and duodenal union,PDDU)癌的CT的表现。方法 对照分析36例PDDU癌的CT表现和手术,病理资料。结果 乳头型20例,管腔内型6例,混合型10例;CT主要表现有较组织肿块,十二指肠壁局限性增厚和共同管,胆总管和胰管扩张等。结论 多数PDDU癌经CT检查可作出正确诊断。 相似文献