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1.
胰胆管合流异常(APBDU)是胰管和胆管在十二指肠壁外汇合,形成共同通道过长,十二指肠乳头部括约肌的作用不能影响整个合流部位,胆汁、胰液互流而引起的胆道、肝脏和胰腺疾病.自APBDU这-概念提出以来,人们进行了大量研究[1],但其发生的病因学机制尚未完全阐明,其与急性胰腺炎、胆道癌,胆管扩张等疾病的因果关系,也仍是进一步深入研究的课题.关于APBDU时胆道和胰腺损伤的报道有很多,我们建立APBDU的实验动物模型来研究肝脏的损伤.  相似文献   

2.
胰胆管合流异常(pancreaticobiliary maljunction,PBM)是指胰胆管汇合部位位于十二指肠壁外或汇合部形态和解剖发生先天性异常的一种情况。而胰腺分裂(pancreas divisum,PD)是胰腺最常见的先天性解剖异常,由胚胎发育时期腹侧胰管与背侧胰管融合失败所致。本文报道1例3岁患儿在ERCP下证实同时存在3种胆胰管解剖异常,除PBM合并PD外,在背侧胰管与胆总管末端之间还存在罕见的交通支,内镜下成功治疗。  相似文献   

3.
ERCP对胰胆管合流异常的诊治   总被引:2,自引:0,他引:2  
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%.  相似文献   

4.
胰胆管合流异常的研究进展   总被引:4,自引:0,他引:4  
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.  相似文献   

5.
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)。  相似文献   

6.
7.
PTC对胰胆管合流异常的诊断   总被引:2,自引:0,他引:2  
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.  相似文献   

8.
胰胆管合流异常影像学诊断和外科治疗原则探讨   总被引:2,自引:0,他引:2  
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.  相似文献   

9.
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.  相似文献   

10.
先天性胆管囊性扩张合并胰胆管合流异常   总被引:4,自引:1,他引:4  
目的 探讨先天性胆管囊性扩张症的诊断与治疗。方法 经内镜塑宪胰胆管造影(ERCP)对该症作出诊断。结果 从本院ERCP1254例中检出15例,本组有8例合并胰胆管合流异常,占53.3%,同时有8例合并其他胰胆疾病,占53.3%。结论 诊断以ERCP为首选,能确诊并可明确有无合并胰胆管合流异常。该症治疗采用早期囊肿切除同时管空肠吻合术,预后良好。  相似文献   

11.
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.  相似文献   

12.
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.  相似文献   

13.
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.  相似文献   

14.
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。  相似文献   

15.
We examined the morphological aspects of the pancreaticobiliary ductal system in 13 patients with both anomalous arrangement of the pancreaticobiliary ductal system (AAPB) and associated pancreas divisum (PD), and compared their clinicopathological findings with those of patients with either AAPB or PD alone. PD is classified into three types, i.e., separate pancreas, nonfusion of the ventral and dorsal pancreatic ducts, and partial fusion of the ventral and dorsal pancreatic ducts. Of the 13 patients with AAPB and associated PD, 5 were male and 8 female; their mean age was 57 years. Nine of the 13 had clinical symptoms. Five of the 13 had gallbladder cancer, 3 had cholecystolithiasis, and 2 choledochal cyst. One patient showed nonfusion of both pancreatic ducts and the others showed partial fusion of the ducts. The length of the common duct from the orifice of the papilla of Vater to the junction of the common bile duct with the ventral pancreatic duct and the location of the union varied. The presence of both AAPB and PD made the arrangement of the pancreaticobiliary ducts very complicated. Clinical aspects were similar to those of AAPB and the patients were likely to be treated for a condition other than PD. However, since relapsing acute pancreatitis and intermittent epigastric pain are typical symptoms in patients with AAPB as well as in those with PD, we should carefully follow up those patients with both AAPB and PD.  相似文献   

16.
We present a case of carcinoma in adenoma of the gallbladder with anomalous pancreaticobiliary ductal junction (APBDJ) in a 60-year-old Japanese woman. The patient had no abdominal symptoms. Serum levels of carcinoembryonic antigen, carbohydrate antigen 19-9, elastase 1, and α-fetoprotein were all within normal limits. Ultrasonography demonstrated two irregular hyperechoic lesions of the gallbladder. Computed tomography showed two soft-tissue density masses in the gallbladder. Endoscopic retrograde cholangiopancreatography showed APBDJ and two protruding lesions in the gallbladder. Angiography displayed a hypervascular lesion fed by the cystic artery. The patient underwent total cholecystectomy; the diagnosis of the intraoperative frozen section was well differentiated adenocarcinoma with possible mucosal invasion. Amylase level in the gallbladder bile was 90600 IU/l. Macroscopically, there were two polyps in the gallbladder. The larger one, 3.5 cm in diameter, was adenocarcinoma in adenoma, and the smaller one, an inflammatory polyp. We briefly discuss the relationship among adenoma, adenocarcinoma of the gallbladder, and APBDJ.  相似文献   

17.
陈炯  徐荣楠 《胰腺病学》2003,3(1):20-22
目的:研究无先天性胆管囊性扩张型的胰胆管汇流异常(APBJ)及其与与胆胰疾病的关系。方法:分析1995年1月-2002年1月间逆行胰胆管造影(ERCP)、术中胆道造影(IOC)、磁共振胰管造影(MRCP)等影像学检查的2150例胆胰疾病中的52例无先天性胆管囊性扩张型APBJ及其与胆胰疾病的关系。结果:本组APBJ的发生率为2.4%,APBJ的检查发现率为ERCP2.9%,IOC2.4%、MRCP2.0%,在52例无先天性胆管囊性扩张型APBJ中有P-C型(胰管注入胆总管)32例、C-P型(胆总管汇入胰管)20例。胆囊上皮增生的发生率为51.9%,胆囊结石的发生率为73.1%,胆囊息肉样病变的发生率为26.9%,急性胰腺炎的发生率为34.6%,结论:APBJ与胆囊疾病关系密切,无先天性胆管囊性扩张型APBJ的胆囊上皮增生和胆囊息肉样病变发生率高,是胆囊癌发生的一个高危因素,对此类型APBJ病人主张预防性胆囊切除,APBJ是胰腺炎发病的一个重要因素,C-P型APBJ的胰腺炎发生率高,在反复胰腺炎发作而无明显原因时,应考虑有APBJ的存在。  相似文献   

18.
The high incidence of biliary tract carcinoma in patients with anomalous pancreaticobiliary ductal junction (APBDJ) with or without choledochal cyst (CC) has been well documented. Twenty-two patients with APBDJ were divided into three groups: Group A, four patients not associated with CC and biliary tract carcinoma; Group B, 13 patients with CC but without biliary tract carcinoma; and Group C, five patients with biliary tract carcinoma (four with and one without CC). Profiles of bile acids in the gall-bladder and/or common bile duct were analysed in these patients and compared with those in the control patients with cholecystlithiasis to examine the hypothesis that the levels of deoxycholic acid (DCA) and lithocholic acid (LCA) are elevated in patients with APBDJ because these secondary bile acids are mutagenic. Bile acids were quantified by gas—liquid chromatography. Total bile acid concentration in the gall-bladder bile was significantly lower in any group with APBDJ than that of controls. In the gall-bladder, increased proportion of chenodeoxycholic acid (CDCA) in Groups A and B, decreased proportion of DCA in Group B and increased proportion of cholic acid (CA) in Group C were found in bile. In the bile duct, total bile acid concentration and proportion of DCA were significantly low in bile from Group C and decreased proportion of DCA and increased proportion of CDCA were found in bile from Group B. In both the gall-bladder and hepatic bile, proportion of LCA was not significantly different between any intergroups. Thus no increase of DCA and LCA was found in either the bile from the gall-bladder and the bile duct of APBDJ patients. It is concluded that bile acid plays little role, if any, in the pathogenesis of biliary tract carcinoma in patients with APBDJ.  相似文献   

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