胰胆管合流异常对胰腺损伤的实验研究

目的 探讨胰胆管合流异常(APBDU)对胰腺的损伤.方法 选择健康杂种猫10只,在胆管、胰管近十二指肠处纵行切开4～6 cm,然后间断吻合,以建立胰胆管合流异常的模型.手术造模时及术后6个月分别取胰腺组织行病理检查、电镜观察及胰腺组织丙二醛(MDA)水平检测.结果 7只猫生存6个月.术后6个月胰腺呈暗红色,充血、水肿,其中3只猫胰腺表面可见扩张的胰管.光镜下见3只猫胰腺有炎性细胞浸润,4只猫胰腺有间质血管增生、白细胞附壁.电镜下见胰腺腺泡细胞粗面内质网扩张,有的呈池状;线粒体数量增多、体积增大、崩解;高尔基复合体发达.手术前胰腺组织MDA水平为(1.23±0.7)nmol/mg prot,术后6个月升高达(2.90±1.9)nmol/mg prot,相差显著(F=4.80,P=0.0215).结论 胰胆管合流异常可导致胰腺损伤,抗氧化可能有助于减轻该损伤.     

ERCP对胰胆管合流异常的诊治

我院1998年9月至2005年4月间,ERCP 507例中共诊断5例胰胆管合流异常（anomalousjunction of pancreaticobiliary duct,APBD）,检出率1%.     

胰胆管合流异常的研究进展

随着人们对胰胆管合流异常(pancreaticobiliary maljunction,PBM)的认识增加,PBM得到了越来越多的重视.PBM与先天性胆管囊肿、胆道结石、非结石性胆囊炎、胆道肿瘤及胆源性胰腺炎等胆胰疾病关系密切,但目前对于胰胆管合流异常相关疾病的发病机制以及治疗等方面还没有完全统一的观点.本文就目前对胰胆管合流异常的研究进展作一综述.     

胰胆管合流异常二例

正1病例介绍病例1患者,男,18岁,因反复上腹痛一年余入院。既往:1年及3个月前因急性胰腺炎住院治疗。血清淀粉酶:2 697 U/L。血常规:白细胞7. 64×109/L,中性粒细胞73. 31%。磁共振胰胆管成像(MRCP):胰胆管合流异常(pancreaticobiliary maljunction,PBM),胰胆管汇合处MRI图像(见图1)。     

PTC对胰胆管合流异常的诊断

目的:探讨经皮肝穿刺胆道造影(percutaneous transhepatic cholangiography,PTC)诊断胰胆管合流异常(pancreaticobiliary maljunction,PBM)的可行性,总结其影像学诊断特征.方法:回顾性分析1999-01/2007-02连续257例因阻塞性黄疸(obstructive jaundice,OJ)PTC下行介入治疗患者的临床及影像学资料,确立病例入选标准与PBM诊断参考标准,从中筛选出资料完整、胰管显影的病例35例,测量胆胰共同管长度和直径、汇合处胆胰管直径、汇合角度等,并经校正得到实际数值,结果经统计学处理.结果:PBM确诊31例,PTC检出率为12.06%.共同管长度为9.88±4.55 mm,明显高于正常长度标准(P＜0.05).十二指肠乳头位置影响共同管长度大小.汇合处胆总管直径、胰管直径、共同管直径分别为3.20±1.62 mm、2.06±0.82 mm和3.03±1.03 mm,与正常值比较无统计学差异.结论:PTC诊断PBM方法可行、安全、有效,PBM的PTC表现具有一定的特征性.     

经内镜逆行胰胆管造影术在胰胆管合流异常诊治中的价值分析

目的探讨胰胆管合流异常（pancreaticobiliary maljunction,PBM）及其相关疾病谱的临床特点,总结治疗性经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)在该病诊治中的应用价值。方法收集2006年6月—2021年3月在北京大学第三医院消化内科因腹痛、黄疸、发热等症状入院行ERCP诊治的52例PBM患者的资料。总结PBM的临床特点、分型、相关疾病谱变化和ERCP诊治过程。结果52例PBM患者中,女性多见,常见临床表现为腹痛和黄疸,其中Ⅰ型20例、Ⅱ型25例 、Ⅲ型7例,合并胆总管囊肿者占50.0%。从首次发病到我院明确诊断为PBM的时间跨度平均为12.2年,其中主要临床问题发生变化的有24例（46.2%）。共进行69例次ERCP操作,5例次患者失败（7.2%）,PBM的困难插管率为34.6%（18/52）,其中11例需借助高级插管技术,同期可比非PBM4 275例ERCP的困难插管率为15.4%（657/4 275）,两者相比差异有统计学意义（χ2=14.455,P＜0.05）。患者行多种治疗性ERCP操作,包括内镜下十二指肠乳头切开术、胰管支架置入术、胆管和胰管结石取石术等,操作成功率为92.8%（64/69）,ERCP术后胰腺炎的发生率为15.4%(8/52)。结论PBM患者的主要临床问题可能随时间发生变化。ERCP技术在PBM及相关疾病的诊治中发挥重要作用,但插管难度较大,术后并发症相对较高。     

胰胆管合流异常影像学诊断和外科治疗原则探讨

目的分析胰胆管合流异常的影像学诊断特点,探讨如何选择合理的手术治疗.方法回顾性分析64例胰胆管合流异常症患者的影像学特点和治疗结果.结果64例患者的胰胆管共同通道平均长度是(19.0±0.6)mm.胰管型患者28例(占43.8%),胆管型32例(占50%),共同通道型4例(占6.2%).对胆肠囊状扩张患者行囊肿切除术,加胆肠吻合术;胆道结石患者行胆囊切除术;对晚期肿瘤行保守治疗,其余肿瘤患者行根治术.结论胰胆管合流异常同许多胆道、胰腺疾病的发生有密切关系.在临床工作中早发现该症患者,给予合理的手术治疗可避免严重合并症的发生.     

胆源性胰腺炎和胰胆管合流异常的关系

目的 探讨胆源性胰腺炎(ABP)和胰胆管合流异常(anomalous pancreaticobiliary ductalunion,APBDU)的关系.方法 选择ABP患者131例,入院后抽取静脉血检查总胆红素(TB)、ALT、AST、ALP,γ-GT.先行非手术治疗,待病情稳定后复查上述指标,然后择期手术,并行术中胆道造影,观察胰胆管合流情况.结果 131例ABP患者中发现APBDU 27例,占20.6%.其中胆总管汇入胰管(Ⅰ型)8例,占29.6%,胰管汇入胆总管(Ⅱ型)16例,占59.3%,复杂型(Ⅲ型)3例,占11.1%.经非手术治疗后,TB、ALT、AST、ALP、γ-GT含量均较入院时明显降低(P＜0.05),其中APBDU患者的ALT为(71.81±23.19)U/L,AST为(47.85±27.87)U/L,γ-GT为(52.86±31.49)U/L,仍明显高于无APBDU患者的(51.96±15.40)U/L、(40.77±16.58)U/L和(34.86±26.47)U/L(P＜0.05).结论 胰胆管合流异常足导致ABP的重要原因之一.     

内镜在胰胆管合流异常诊疗中的作用探讨

目的探讨ERCP在胰胆管合流异常中的诊断价值,评估内镜治疗的效果。方法16例胰胆管合流异常（PBM）患者,通过ERCP造影进行PBM分型,结合临床症状,分析引起相关疾病的机制、影像特点,根据合并的其它胰胆疾病,选择适当的内镜取石、扩张或引流等治疗,观察治疗效果。结果16例胰胆管合流异常患者多伴有腹痛、呕吐、黄疸等症状,及转氨酶和／或淀粉酶水平的升高。其中,Ⅰ型（B—P型）7例,Ⅱ型（P—B型）5例,Ⅲ型（复杂型）4例;合并胆总管囊肿扩张10例,无扩张者5例,胆管癌并狭窄1例;伴有胆管结石11例（4例为蛋白栓）、胰管结石2例（1例不伴胆管结石）。9例予内镜下胆管取石,2例胰管取石,术中置入胆道支架引流7例,行鼻胆管引流3例,胰管支架置入5例,胆道金属支架置人1例。术后临床症状均明显缓解。结论ERCP是一种可靠的诊断手段,其分型与PBM相关疾病表现有明显相关,选择性、暂时性的内镜治疗在外科术前是有效的、必要的。     

Multiseptate gallbladder with anomalous pancreaticobiliary ductal union： A case report

Multiseptate gallbladder, characterized by the presence of multiple septa dividing the gallbladder lumen, is a very extremely rare congenital anomaly of the gallbladder. On the other hand, anomalous pancreaticobiliary ductal union is also one of the congenital anomalous biliary diseases and thought to be related with choledochal cyst or biliary tract malignancies. In this paper, we describe a unique and first patient of multiseptate gallbladder with anomalous pancreaticobiliary ductal union and a review of the literature. To clarify more characters of the multiseptate gallbladder,examination of a larger patient population will be needed and further studies will be required.     

Association between anomalous pancreaticobiliary ductal union and adenomyomatosis of the gall-bladder

A frequent association of biliary tract carcinoma and anomalous pancreaticobiliary ductal union (APBD) is well recognized, especially gall-bladder carcinoma in undilated type APBD. However, little is known about the presence and incidence of adenomyomatosis (AMT) of the gall-bladder, a presumed premalignant lesion, in patients with APBD. This retrospective study was conducted to elucidate the clinical features and incidence of AMT in APBD patients with relation to undilated type and dilated type APBD. We reviewed the clinicopathological records of 30 patients with APBD (28 women and two men) encountered during the past 10 years. Among them, 22 patients underwent cholecystectomy and the resected specimens were subjected to histopathological examinations. Eleven cases of APBD patients were undilated type and 11 cases were dilated type. Adenomyomatosis was found in six (55%) of 11 undilated type and one (9%) of 11 dilated type, and fundal type was predominantly observed in six (86%) of seven AMT. An overall incidence of AMT in APBD patients was 32%. An undilated type of APBD is frequently associated with AMT and we believe, therefore, that clinicians should be aware of a possible coexistence of APBD and AMT.     

Amylase level in extrahepatic bile duct in adult patients with choledochal cyst plus anomalous pancreatico-biliary ductal union

AIM: To investigate the relationship between pancreatic amylase in bile duct and the clinico-pathological features in adult patients with choledochal cyst and anomalous pancreatico-biliary ductal union (APBDU). METHODS: From 39 patients who underwent surgery for choledochal cyst between March 1995 and March 2003, we selected 15 adult patients who had some symptoms and were radiologically diagnosed as APBDU, and their clinico-pathological features were subsequently evaluated retrospectively. However, we could not obtain biliary amylase in all the patients because of the surgeon's slip. Therefore, we measured the amylase level in gall bladder of 10 patients and in common bile duct of 11 patients. RESULTS: Levels of amylase in common bile duct and gall bladder ranged from 11 500 to 212 000 IU/L, and the younger the patients, the higher the biliary amylase level (r= -0.982, P<0.01). Pathologically, significant correlation was found between the size of choledochal cyst and the grade of inflammation (r= 0.798, P<0.01). And, significant correlation was found between the level of amylase in gall bladder and the grade of hyperplasia. On the other hand, there was no correlation to the age of symptomatic onset or inflammatory grade (r = 0.743, P<0.05). Level of lipase was elevated from 6 000 to 159 000 IU/L in bile duct and from 14 400 to 117 000 IU/L in the gall bladder; however, there was no significant correlation with age or clinico-pathological features. CONCLUSION: The results support the notion that amylase has a particular role in the onset of symptoms, and suggest that a large amount of biliary amylase induces early onset of symptom, thereby making early diagnosis possible.     

先天性胆胰管合流异常的内镜诊断与治疗

目的探讨ERCP对胆胰管合流异常（APBDJ）的诊断价值与临床处理原则。方法回顾分析近5年来接受ERCP诊疗的患者中,APBDJ的发生情况、分型特点、与合并胆胰疾病的关系,以及内镜下处理的情况。结果探讨ERCP对胆胰管合流异常（APBDJ）的诊断价值与临床处理原则。方法回顾分析近5年来接受ERCP诊疗的患者中,APBDJ的发生情况、分型特点、与合并胆胰疾病的关系,以及内镜下处理的情况。结论ERCP是APBDJ一种直接、可靠的诊断手段;APBDJ与胆囊癌、胆总管囊肿及慢性胰腺炎等症有非常密切的关联;APBDJ患者可根据合并症的具体情况,采取相应的内镜治疗措施。     

Melatonin ameliorates experimental hepatic fibrosis induced by carbon tetrachloride in rats

AIM： To investigate the protective effects of melatonin on carbon tetrachloride （CCl4）-induced hepatic fibrosis in experimental rats.
METHODS： All rats were randomly divided into normal control group, model control group treated with CCl4 for 12 wk, CCl4 ＋ NAC group treated with CCl4 ＋ NAC （100 mg/kg, i.p.） for 12 wk, CCl4 ＋ MEL-1 group treated with CCl4 ＋ melatonin （2.5 mg/kg） for 12 wk, CCl4 ＋ MEL-2 group treated with CCl4 ＋ melatonin （5.0 mg/kg） for 12 wk, and CCl4 ＋ MEL-3 group treated with CCl4 ＋ melatonin （10 mg/kg）. Rats in the treatment groups were injected subcutaneously with sterile CCl4 （3 mL/kg, body weight） in a ratio of 2：3 with olive oil twice a week. Rats in normal control group received hypodermic injection of olive oil at the same dose and frequency as those in treatment groups. At the end of experiment, rats in each group were anesthetized and sacrificed. Hematoxylin and eosin （HE） staining and Van Gieson staining were used to examine changes in liver pathology. Serum activities of alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and protein concentration weremeasured with routine laboratory methods using an autoanalyzer. Hydroxyproline （HYP） content in liver and malondialdehyde （MDA） and glutathione peroxidase （GPx） levels in liver homogenates were assayed by spectrophotometry. Serum hyaluronic acid （HA）, laminin （LN）, and procollagen Ⅲ N-terminal peptide （PⅢNP） were determined by radioimmunoassay.
RESULTS： Pathologic grading showed that the fibrogenesis was much less severe in CCl4 ＋ MEL3 group than in model control group （u = 2.172, P 〈 0.05）, indicating that melatonin （10 mg/kg） can significantly ameliorate CCl4-induced hepatic fibrotic changes. The serum levels of ALT and AST were markedly lower in CCl4 ＋ MEL treatment groups （5, 10 mg/kg） than in model control group （ALT： 286.23 ± 121.91 U/L vs 201.15 ± 101.16 U/L and 178.67 ± 103.14 U/L, P = 0.028, P = 0.007; AST： 431.00 ± 166.35 U/L vs 321.23 ± 162.48 U/L and 292.42 ± 126.23 U/L, P = 0.043, P = 0.013）. Similarly, the serum laminin （LN） and hyaluronic acid （HA） levels and hydroxyproline （HYP） contents in liver were significantly lower in CCl4 ＋ MEL-3 group （10 mg/kg） than in model control group （LN： 45.89 ± 11.71 μg/L vs 55.26 ± 12.30 μg/L, P = 0.012; HA： 135.71±76.03 μg/L vs 201.10 ± 68.46 μg/L, P = 0.020; HYP： 0.42 ± 0.08 mg/g tissue vs 0.51 ± 0.07 mg/g tissue, P = 0.012）. Moreover, treatment with melatonin （5, 10 mg/kg） significantly reduced the MDA content and increased the GPx activity in liver homogenates compared with model control group （MDA： 7.89 ± 1.49 noml/mg prot vs 6.29 ±1.42 noml/mg prot and 6.25 ±2.27 noml/mg prot, respectively, P = 0.015, P = 0.015; GPx： 49.13 ±8.72 U/mg prot vs 57.38 ±7.65 U/mg prot and 61.39 ±13.15 U/mg prot, respectively, P = 0.035, P = 0.003）.
CONCLUSION： Melatonin can ameliorate CCl4 -induced hepatic fibrosis in rats. The protective effect of melatonin on hepatic fibrosis may be related to its antioxidant activities,     

Histological study of gallbladder and bile duct epithelia in patients with anomalous arrangement of the pancreaticobiliary ductal system: comparison between those with and without a dilated common bile duct

Background We histologically evaluated the epithelia of the gallbladder (GB) and bile duct (BD) in patients with anomalous arrangement of the pancreaticobiliary ductal system (AAPB), with regard to the shape of the common BD (CBD). Methods The GB and BD were studied histologically using surgical materials from 44 patients with AAPB: 27 with a dilated CBD (D-type) and 17 with a nondilated CBD (N-type). Results GB cancer and BD cancer were found in 11.1% and 3.7% of D-type and 17.6% and 0% of N-type respectively. Hyperplastic epithelium and atypical epithelium of the GB were frequently seen in both D-type (46%, 46%) and N-type (82%, 70%), while such epithelia of the BD were only seen in D-type (10%, 35%). The Ki67 labeling index of the nonneoplastic epithelium of the GB was high in both D-type (13.0%) and N-type (9.7%), though that of the BD was high in D-type (12.5%) but low in N-type (1.8%). The prevalences of pyloric gland metaplasia, intestinal metaplasia, and p53 protein overexpression of the nonneoplastic epithelium did not show any significant differences between D-type and N-type. Conclusions It is suggested that the BD epithelium of N-type probably has a lower potential for developing malignancy than that of D-type, while the GB epithelia of both D-type and N-type have a high potential for developing malignancy. This might support the selection of simple cholecystectomy as the treatment of choice in AAPB patients of N-type, although further investigation of the BD epithelium is required in a larger number of such patients.     

肝脏肿瘤缺血再灌注损伤后超氧化物歧化酶和丙二醛的改变及意义

目的　探讨缺血再灌注对肿瘤组织的影响及其意义。方法　通过超声引导将VX2肿瘤组织混悬液穿刺注射到新西兰兔肝脏左中叶 ,建立肝脏肿瘤模型 ,用无损伤血管钳阻断肿瘤所在肝叶的肝动脉分支 60min后去除血管阻断恢复血流 ,随机将模型动物分为缺血再灌注前 (对照 )、缺血再灌注后 0min、1h、1d、3d、1周 6个时间组 ,取肝脏组织和肿瘤组织 ,分别测定超氧化物歧化酶 (SOD)和丙二醛 (MDA)的含量。结果　肝脏组织中的SOD含量于缺血再灌注后迅速下降 ,至 0min达最低点 ,随后有所升高 ,至 7d时仍明显低于缺血再灌注前水平 ,各组与对照组对比差异显著 (P <0 .0 0 1) ,而肿瘤组织的SOD含量变化趋势除了 1h达最低点外 ,其余皆与肝脏组织相似 ,各组与对照组对比差异显著 (P<0 .0 0 1) ;肝脏组织的MDA含量于 0min时升至最高 ,随后开始下降 ,至 7d时仍高于缺血再灌注前水平 ,各组与对照组对比差异显著 (P <0 .0 0 1) ,而肿瘤组织的MDA含量于 1h降至最低 ,随后有所升高 ,但至 7d时仍明显低于缺血再灌注前水平 ,各组与对照组比较差异显著 (P <0 .0 0 1)。结论　肿瘤组织缺血再灌注后氧自由基的生成和损伤较正常肝脏组织明显。     

大蒜素对高脂饮食致大鼠肝慢性损伤的影响

目的观察大蒜素对高脂饮食致大鼠发生肝脏慢性损伤时,大鼠肝功能及肝组织病理形态学的变化。方法以高脂饮食复制大鼠慢性肝损伤组模型,大蒜素分别按大剂量（1 ml/kg）、小剂量（0.5 ml/kg）灌胃给药。分别于4周、8周、12周末腹主动脉采血测定血浆丙氨酸氨基转移酶（ALT）,取肝组织用于组织病理切片的制备及丙二醛（MDA）及甘油三脂（TG）水平的检测。结果大蒜素可降低血清ALT、肝脏MDA及4周末TG水平;减轻肝细胞脂肪变性或炎症细胞的浸润。结论大蒜素对高脂饮食致大鼠肝慢性损伤有明显保护作用。