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1.
T Ohta T Nagakawa K Ueno K Maeda N Ueda M Kayahara T Akiyama M Kanno I Konishi R Izumi 《The Japanese journal of surgery》1990,20(1):36-43
Between 1978 and 1988, 15 patients with gallbladder cancer and 2 patients with bile duct cancer were seen among 49 patients with anomalous union of the pancreaticobiliary ductal system. Radiographic findings revealed two types of this anomalous condition: one in which the pancreatic duct entered the common bile duct (type 1) and one in which the common bile duct entered the pancreatic duct (type 2). In gallbladder cancer, the common bile duct presented no dilatation, or in some patients, mild dilatation, and type-1 anomalous union was frequently found among these patients. In contrast, the two patients with bile duct cancer had cystic dilatation of the common bile duct and type-2 anomalous union. The bile amylase level, which was determined in seven patients, was extremely high in all the patients. Histopathologically, the tumors in most patients showed papillary to papillo-tubular proliferation in the mucosal layer while atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that this congenital anomaly in both ducts results in a loss of the normal sphincteric mechanism of the duodenal papilla, and that chronic relapsing cholecystitis or cholangitis, caused by the reflux of pancreatic juice into the biliary tract, can induced progressive changes to atypical epithelial hyperplasia which may develop into carcinoma. 相似文献
2.
We report the case of a ball-valve gastric tumor associated with anomalous junction of the pancreatico-biliary ductal system
(AJPBDS) and a right-sided round ligament, misdiagnosed preoperatively as advanced gastric cancer with pancreatic head invasion.
A 72-year-old woman presented with chest pain, but laboratory data showed only anemia. Gastroscopy revealed a bleeding polypoid
gastric tumor in the anterior wall of the stomach, herniating into the duodenum (ball-valve syndrome), and a Bormann type-2
tumor in the posterior wall. Ultrasonography showed gallbladder stones, dilatation of the intrahepatic bile duct and pancreatic
duct, and a left-sided gallbladder (attributed to a right-sided round ligament with anomalous branches of the portal veins).
Laparotomy revealed that the gastric tumors were not advanced cancer invading the pancreatic head. Intraoperative cholangiography
showed an AJPBDS, causing dilatation of the intrahepatic bile duct and pancreatic duct. We performed distal gastrectomy and
cholecystectomy without biliary diversion. Microscopy revealed that the polypoid tumor was a hyperplastic polyp. 相似文献
3.
Mucosal cell proliferation activity of the gallbladder in children with anomalous arrangement of the pancreaticobiliary duct 总被引:1,自引:0,他引:1
Kazuaki Tokiwa Shigeru Ono Naomi Iwai 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(3):213-217
Anomalous arrangement of the pancreaticobiliary duct (AAPBD) is an anatomical maljunction of the bile duct and the pancreatic
duct that is frequently associated with gallbladder carcinoma. In patients with AAPBD, it has been postulated that pancreatic
juice regurgitates into the biliary tree, and the mixture of refluxed pancreatic juice and stagnant bile juice acts as an
irritant factor to the biliary tract epithelium, leading to chronic inflammation and metaplasia. Eventually these mucosal
changes may progress to invasive carcinoma. We reviewed clinicopathologic studies on epithelial changes of the gallbladder
in patients with AAPBD to clarify the implications relevant to carcinogenesis. Conventional histological studies have shown
that the most characteristic change observed in the gallbladder of children with this anomaly was epithelial hyperplasia.
Furthermore, the incidence of mucosal hyperplasia was significantly increased in the gallbladder of children in whom the pancreatic
duct joined the common bile duct (P-C type) compared with the incidence in children in whom the common bile duct joined the
pancreatic duct (C-P type). In addition, cell kinetic studies have demonstrated increased cellular proliferative activity
of the gallbladder in children with AAPBD. Cell proliferative activity was significantly elevated in children with the P-C
type of AAPBD compared with that in children with the C-P type of anomaly. In conclusion, AAPBD may yield increased cell proliferation
in the gallbladder of patients with this anomaly in early childhood, resulting in epithelial hyperplasia. Although it remains
unknown which agents are responsible for promoting the activation of cellular function, it seems that bile acids and refluxed
pancreatic proteases are likely play a role in such promotion. Further investigations are needed to elucidate the mechanism
of increased cellular function.
Received for publication on Jan. 29, 1999; accepted on March 29, 1999 相似文献
4.
Takahiko Funabiki Toshiki Matsubara Masahiro Ochiai Yoshihisa Marugami Yoichi Sakurai Shigeru Hasegawa Hiroki Imazu 《Journal of Hepato-Biliary-Pancreatic Surgery》1997,4(4):405-411
The coexistence of bile duct carcinoma in choledochal cysts is well known. With large number of cases of congenital bile duct
dilatation and pancreaticobiliary maljunction (PBM), it is now apparent that gallbladder carcinoma is more frequent in PBM
without bile duct dilatation. The incidence of Gallbladder cancer in choledochal cyst and bile duct cancer in PBM, regardless
of the presence of bile duct dilatation is significantly higher than that in control patients with biliary cancer but without
PBM. A recent survey shows that the incidence of bile duct cancer in PBM without dilatation is equivalent to that of gallbladder
cancer and bile duct cancer in patients with choledochal dilatation. Pathology in PBM is a result of reflux of pancreatic
juice and stasis of the mixture in the biliary system. Carcinogenic factors thus present in the biliary contents induce epithelial
changes in the biliary tract. In the biliary contents, activated pancreatic enzymes and secondary or deconjugated bile acids
are markedly increased and they irritate the biliary mucosa. Mutagens are proven to form in the bile of PBM. In the epithelia
of PBM, hyperplasia, metaplasia, and dysplasia are often found, and proliferative activity is increased; furthermore, K-ras gene mutation and overexpression of p53 protein are demonstrated. As for treatment of PBM, whether it is symptomatic or not,
an operative procedure, is necessary, to prevent carcinogenic changes in the gallbladder and bile duct. Regardless of whether
dilatation is present or not, total excision of the extrahepatic bile duct, along with gallbladder, is the treatment of choice,
followed by hepaticojejunostomy or hepaticoduodenostomy. 相似文献
5.
Luis Enrique Loria Kensuke Yamamoto Toshifumi Eto Tsutomu Tomioka Toshimitsu Miyamoto Nobuo Mochinaga Ryoichi Tsuchiya MD 《Surgery today》1988,18(6):718-724
A 39 year-old Japanese female patient with a duplication of the distal portion of the common bile duct is presented herein.
Moreover, an abnormal arrangement of the pancreaticobiliary ductal union, congenital biliary dilatation and carcinoma of the
gallbladder were all demonstrated by cholangiographic and endoscopical studies. The patient underwent radical surgery for
advanced adenosquamous carcinoma of the gallbladder, and her postoperative course was satisfactory. A reflux of pancreatic
juice into the bile duct was demonstrated, but it was eliminated and considered to be a contributory etiologic factor of the
gallbladder carcinoma. 相似文献
6.
Cellular activity in the gallbladder of children with anomalous arrangement of the pancreaticobiliary duct. 总被引:1,自引:0,他引:1
BACKGROUND/PURPOSE: Anomalous arrangement of the pancreaticobiliary duct (AAPBD) is closely related to congenital biliary dilatation and frequently associated with biliary tract malignancy. To examine the mechanism of biliary tract carcinogenesis in patients with AAPBD, we investigated histologically the early changes in cell proliferative kinetics of the gallbladder mucosa of children with AAPBD. METHODS: Twenty-three specimens of gallbladder were obtained from 23 children with AAPBD, and six control specimens were obtained from pediatric patients. All specimens were fixed routinely and paraffin embedded and examined histologically with H&E staining and immunohistochemically with monoclonal antibody Ki-67(MIB-1), which reacts with a human nuclear antigen associated with cell proliferation. Ki-67 labeling index (Ki-67 LI) was obtained by counting the numbers of Ki-67-positive cells per 1,000 gallbladder epithelial cells. RESULTS: Significant differences in Ki-67 LI were noted between children with and without AAPBD. Furthermore, Ki-67 LI and the incidence of epithelial hyperplasia of gallbladder were significantly higher in children with AAPBD in whom the major pancreatic duct joined the common bile duct (P-C type) than in those in whom the common bile duct joined the major pancreatic duct (C-P type). CONCLUSIONS: Cellular proliferative activity was increased in children with AAPBD, especially those with the P-C-type anomaly. These results suggest that the early mucosal changes of the gallbladder occurred in early childhood of patients with AAPBD and might be associated with gallbladder cancer. Early diagnosis and early surgical division of the biliary tract and pancreatic duct is recommended for children with AAPBD. 相似文献
7.
Takahiko Funabiki Toshiki Matsubara Shuichi Miyakawa Shin Ishihara 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(1):159-169
Background It is widely accepted that congenital choledochal cyst is associated with pancreaticobiliary maljunction (PBM). But, PBM is
an independent disease entity from choledochal cyst. PBM is synonymous with “abnormal junction of the pancreaticobiliary ductal
system”, “anomalous arrangement of pancreaticobiliary ducts”, “anomalous union of bilio-pancreatic ducts”, etc. Cases with
PBM not associated with biliary duct dilatation are often found, and these cases are frequently complicated gallbladder cancer.
The Japanese Study Group of Pancreaticobiliary Maljunction was started in 1983, and defined diagnostic criteria and nationwide
registration system of PBM cases was started. PBM is defined as a union of the pancreatic and biliary ducts which is located
outside the duodenal wall. Bile and pancreatic juice reflux and regurgitate mutually.
Biliary carcinogenesis The most bothersome problem is biliary carcinogenesis. Gallbladder cancers arise in 14.8% and bile duct cancers arise in 4.9%.
The incidence of the gallbladder carcinoma of PBM without bile duct dilatation is 36.1%. Many investigators have tried to
clarify the carcinogenic process, from various aspects. The biliary epithelia are injured by harmful substances, and in the
course of repair, multiple alterations of oncogenes and tumor suppressor genes are followed, and they lead to carcinoma through
multistage interaction. In the biliary epithelia of PBM, incidence and degree of hyperplasia are characteristic. K-ras gene mutations are observed in the cancerous as well as noncancerous lesions of biliary tract of PBM patients. Mutations
of p53 gene and overexpression of p53 protein are also found in the cancerous and noncancerous lesions. These changes are called “hyperplasia–carcinoma sequence”.
Treatment Total excision of the extrahepatic bile duct with gallbladder followed by hepaticojejunostomy, Roux-en-Y, or end-to-side hepaticoduodenostomy
are treatment of choice, even for cases with not dilated bile duct, because the incidence of cancer in the nondilated bile
duct is not negligible, and genetic changes are seen in a nondilated bile duct. 相似文献
8.
Tashiro S Imaizumi T Ohkawa H Okada A Katoh T Kawaharada Y Shimada H Takamatsu H Miyake H Todani T;Committee for Registration of the Japanese Study Group on Pancreaticobiliary Maljunction 《Journal of Hepato-Biliary-Pancreatic Surgery》2003,10(5):345-351
Pancreaticobiliary maljunction (PBM) is a congenital anomaly defined as a union of the pancreatic and biliary duct that is located outside the duodenal wall. The Japanese Study Group on Pancreaticobiliary Maljunction and the Committee for Registration enrolled and analyzed 1627 patients with PBM who had been diagnosed and treated from January 1, 1990 to December 31, 1999 at 141 hospitals throughout the country. There were 1239 patients with dilatation of the bile duct (group A) and 388 patients without dilatation (group B). The average age was 24 years in group A and 47 years in group B; the age was significantly higher in group B. The type of confluence between the terminal choledochus and the pancreatic duct has been classified into three types (type a, right-angle type; type b, acute-angle type; and type c, complex type). In group A, type a accounted for 57.9% and was significantly more frequent compared with the other types (type b, 32.4%; type c, 5.6%). In group B, type b accounted for 60.8%, being significantly more frequent compared with the other types (type a, 29.4%; type c, 7.2%). Subjective symptoms, preoperative complications (e.g., liver dysfunction and acute pancreatitis), pancreatic stone, and pancreatic duct morphological abnormality were significantly more frequent in group A. However, the amylase levels in the bile and gallbladder were significantly higher in group B, and the presence of gallstone and morphological abnormality of the gallbladder was significantly more frequent in group B. The occurrence rate of cancer in the biliary tract was 10.6% in group A and 37.9% in group B, being significantly higher in group B. In group A, cancer of the extrahepatic bile duct was seen in 33.6% and cancer of the gallbladder was seen in 64.9%, but gallbladder cancer was present significantly more frequently in the patients with diffuse or cylindrical dilatation, and bile duct cancer was present significantly more frequently in the patients with cystic dilatation. In group B, 93.2% of the patients had gallbladder cancer, and bile duct cancer was found in as few as 6.8%. Against this background Japanese surgeons regard cholecystectomy, resection of the extrahepatic bile duct, and hepaticojejunostomy as standard operations for PBM with dilatation of the bile duct. However, opinion on whether or not the bile duct should be removed in the treatment of PBM without dilatation of the bile duct has been divided among Japanese surgeons. A randomized controlled trial is necessary. 相似文献
9.
J. Itakura H. Fujii Y. Matsumoto K. Suda 《Journal of Hepato-Biliary-Pancreatic Surgery》1994,1(3):240-246
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
10.
Itoh T Fuji N Taniguchi H Yasukawa S Yasuda H Wakabayashi N Watanabe T Kosuga T Kashimoto K Yanagisawa A Naito K 《Journal of Hepato-Biliary-Pancreatic Surgery》2008,15(3):338-343
We report a case of double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct. A 73-year-old woman was admitted to the hospital complaining of upper abdominal pain. Endoscopic retrograde cholangiography showed a stenotic lesion in the lower common bile duct and no visualization of the cystic duct or gallbladder. Enhanced computed tomography revealed a heterogeneously enhanced tumorous lesion around the lower bile duct in the pancreatic head. A diagnosis of cancer arising from the cystic duct that entered the lower part of the common hepatic duct was made by intraductal ultrasonography, which showed an intraluminal protruding lesion in the cystic duct. Isolated gallbladder cancer was also diagnosed, by abdominal computed tomography. She underwent pancreaticoduodenectomy with dissection of regional lymph nodes. Histological examination revealed moderately differentiated adenocarcinoma of the cystic duct and well-differentiated adenocarcinoma of the gallbladder. Double cancer of the cystic duct and gallbladder is extremely rare, and this case also suggests a relationship between a low junction of the cystic duct and neoplasm in the biliary tract. 相似文献
11.
We describe 3 children with dilatation of the intrahepatic bile duct, who had anomalous junctions of the cystic duct, 2 high and 1 low, without pancreaticobiliary maljunction. They were all male, and underwent excision of the gallbladder and the extrahepatic bile duct followed by a Roux-en-Y hepaticojejunostomy as a definitive surgery. Postoperatively, the dilated intrahepatic bile duct became normal in size. From these 3 cases, we propose a new disease entity—dilatation of the intrahepatic bile duct because of congenital anomalous junction of the cystic duct. 相似文献
12.
Tuech JJ Pessaux P Aube C Regenet N Cervi C Bergamaschi R Arnaud JP 《Journal of Hepato-Biliary-Pancreatic Surgery》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.
Received for publication on Dec. 15, 1999; accepted on Feb. 22, 2000 相似文献
13.
十二指肠乳头内生性腺瘤内镜下诊断与治疗(附8例报告) 总被引:1,自引:0,他引:1
目的探讨十二指肠乳头内生性腺瘤的内镜下诊治方法。方法2005年6月~2008年10月对8例B超、MRCP影像学检查提示胆总管及肝内胆管不同程度的扩张,乳头开口及下段狭窄,进一步行ERCP及IDUS检查,发现病变并予以治疗。结果2例绒毛管状腺瘤伴上皮中度不典型增生及1例管状腺瘤行胰十二指肠乳头切除术:1例绒毛管状腺瘤术后病理局部癌变,3个月后肝转移行介入化疗及栓塞2次,16个月全身复查未见异常;1例管状腺瘤伴上皮中度不典型增生者术后病理局部印戒细胞癌,术后6、14个月随访全身复查未见异常。1例管状乳头状腺瘤行十二指肠乳头内镜下切除术后置入胆管支架内引流,6个月后复发并癌变,术后10个月死亡;1例绒毛管状腺瘤伴上皮中度不典型增生行十二指肠乳头内镜下切除术后置入胆管支架内引流,术后6、12个月复查未见异常;1例绒毛管状腺瘤伴上皮中度不典型增生术后病理与术前相同,且切除干净,未随访。1例绒毛状管状腺瘤伴高级上皮内瘤变,胆道塑料支架置入术,术后4个月反复胆道感染,内镜下更换为金属支架。1例乳头状腺瘤置入胆管支架内引流,术后失访。1例管状腺瘤拒绝治疗,电话至12个月随访无异常不适。结论十二指肠乳头内生性腺瘤临床罕见,且易于癌变,对乳头切开后黏膜层及肌层增厚的患者尤其有增生性病变者应常规多点取活检,避免乳头内腺瘤及恶性变病灶的遗漏,并对相关病灶及时内镜下或手术治疗。 相似文献
14.
Clinical experience of intrahepatic cholangiocarcinoma associated with hepatolithiasis 总被引:1,自引:0,他引:1
Tetsuo Ohta MD Takukazu Nagakawa Ichiro Konishi Keiichi Ueno Masahiro Kanno Takayaoshi Akiyama Masato Kayahara Ryohei Izumi Kohji Konishi Itsuo Miyazaki Makoto Uogishi Hiroshi Sodani 《Surgery today》1988,18(1):47-53
Between 1960 and 1986, seven patients with intrahepatic cholangiocarcinoma and one patient with intrahepatic bile duct adenoma,
related to hepatolithiasis, were seen among 112 cases of hepatolithiasis. Histopathologically, the tumors associated with
hepatolithiasis arose from the periphery of the stone-containing bile duct, spread chiefly along the luminal surface, and
invaded the ductal wall or periductal tissue. The tumors showed papillary to papillo-tubular proliferation and were diagnosed
as the intraductal or periductal spreading type of cholangiocarcinoma. In addition, atypical epithelial hyperplasia was noted
in the vicinity of the tumor area. These findings suggest that chronic relapsing cholangitis in patients with hepatolithiasis
can induce progressive changes to atypical epithelial hyperplasia which may develop into cholangiocarcinoma. 相似文献
15.
Sumitomo Kato Tsukasa Nakagawa Hitoya Kobayashi Eitatsu Arai Kazushi Isetani 《Surgery today》1994,24(6):534-537
We herein describe a 48-year-old woman who developed a septum formation of the bile duct combined with an anomalous arrangement of the pancreaticobiliary ductal system in conjunction with gallbladder cancer. A preoperative endoscopic retrograde cholangiogram demonstrated a filling defect in the common hepatic duct which was misdiagnosed to be an elevated lesion. Further exploration revealed a septum formation of the bile duct along with gallbladder cancer. A resection of the dilated bile duct and gallbladder along with a dissection of the regional lymph nodes was performed. A histological evaluation showed the septum to consist of a normal bile duct wall while the tumor in the gallbladder was poorly differentiated adenocarcinoma. The patient made an uneventful recovery. The septum formation was presumed to be congenital in origin. 相似文献
16.
Cylindrical dilatation of the choledochus: a special type of congenital bile duct dilatation 总被引:3,自引:0,他引:3
Cylindrical dilatation of the choledochus develops in 20% of patients with congenital bile duct dilatation and usually has acute-angled unions of the pancreatobiliary ductal system. Symptoms generally develop in patients over 1 year of age. The patients frequently complain of abdominal pain, vomiting, and fever as in those with acute pancreatitis. Ultrasonography and infusion cholangiography are the most useful tools in making a correct diagnosis. A high amylase level in the bile caused by the refluxing of pancreatic juice through anomalous ductal unions is commonly observed. This is responsible for biliary perforation in infancy and possibly carcinoma arising in the bile duct. The amylase concentration in the serum at the time of epigastric pain often is high, which leads to the diagnosis of acute pancreatitis. However, evidence of pancreatic inflammation is seldom noted. Accordingly, amylase in the bile may enter the circulating blood through the denuded epithelium or sinusoids of the liver. Excision of the whole extrahepatic duct along with hepaticoenterostomy would be essential for the treatment of cylindrical dilatation of the bile duct, especially when an anomalous ductal union is present. 相似文献
17.
Long-term results of treatment for pancreaticobiliary maljunction without bile duct dilatation 总被引:3,自引:0,他引:3
Ohuchida J Chijiiwa K Hiyoshi M Kobayashi K Konomi H Tanaka M 《Archives of surgery (Chicago, Ill. : 1960)》2006,141(11):1066-1070
HYPOTHESIS: Resection of the gallbladder together with the dilated bile duct is the preferred treatment for pancreaticobiliary maljunction (PBM) with bile duct dilatation, whereas this treatment for PBM without bile duct dilatation is still controversial. DESIGN: Retrospective study of 196 patients from January 1979 to November 2004. SETTING: Two university hospitals. PATIENTS: One hundred ninety-six patients with PBM, 152 (78%) with and 44 (22%) without bile duct dilatation, formed the basis of this study. MAIN OUTCOME MEASURES: The effects of cholecystectomy on long-term results in the patients without bile duct dilatation. RESULTS: Significant differences were observed in patients without bile duct dilatation: patients were older, carcinoma of the gallbladder was more prevalent (19 patients [43.2%] without dilatation vs 9 patients [5.9%] with dilatation), and pancreatic cancer and pancreatitis were also more frequent. Most of their gallbladder carcinomas were found at stage IV (63%). The outcome was very poor in stage IV, whereas 5 patients in stage I and II lived for more than 5 years after surgery. Of the 44 patients without bile duct dilatation, 23 with carcinoma of the gallbladder or pancreas died and the other 2 were lost to follow-up. The remaining 19 patients were alive at the study's conclusion after cholecystectomy without bile duct resection. None of them had bile duct carcinoma at the time of surgery or during the mean follow-up period of 9 years after surgery. CONCLUSIONS: Prophylactic cholecystectomy without bile duct resection is the best treatment option for patients with PBM without bile duct dilatation. Possible association of gallbladder carcinoma should be kept in mind at the time of treatment of patients with PBM when the bile duct is not dilated. 相似文献
18.
A case of a rare anomaly of the common bile duct associated with an abnormal arrangement of the pancreaticobiliary ductal union 总被引:1,自引:0,他引:1
L E Loria K Yamamoto T Eto T Tomioka T Miyamoto N Mochinaga R Tsuchiya 《The Japanese journal of surgery》1988,18(6):718-724
A 39 year-old Japanese female patient with a duplication of the distal portion of the common bile duct is presented herein. Moreover, an abnormal arrangement of the pancreaticobiliary ductal union, congenital biliary dilatation and carcinoma of the gallbladder were all demonstrated by cholangiographic and endoscopical studies. The patient underwent radical surgery for advanced adenosquamous carcinoma of the gallbladder, and her postoperative course was satisfactory. A reflux of pancreatic juice into the bile duct was demonstrated, but it was eliminated and considered to be a contributory etiologic factor of the gallbladder carcinoma. 相似文献
19.
Epithelial cell proliferation activity of the biliary ductal system with congenital biliary malformations 总被引:4,自引:0,他引:4
Hideki Fujii Yang Yang Ruifang Tang Kazuyosi Kunitomo Jun Itakura Masatosi Mogaki Masanori Matsuda Koichi Suda Bunsei Nobukawa Yoshiro Matsumoto 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(3):294-302
Congenital biliary malformations such as anomalous arrangement of the pancreaticobiliary ductal system (AAPB), congenital
cystic dilatation of the common bile duct (CCDB), and congenital biliary strictures at the hepatic hilum (CBSH) are newly
designated disease entities and are frequently found in adult patients with biliary malignancy such as gallbladder carcinoma,
common bile duct carcinoma, and intrahepatic bile duct carcinoma. In the present study, the relationship of these malformations
and biliary malignancy was investigated. We studied 61 gallbladders of patients with AAPB and 56 gallbladders of patients
without AAPB; 16 common bile ducts of patients with CCDB (12 with AAPB and 4 without AAPB) and 11 gallbladders of patients
without CCDB; and 17 intrahepatic bile ducts of patients with CBSH and 6 intrahepatic bile ducts of patients without CBSH.
Tissue sections from the mucosa of the gallbladder, common bile duct, and intrahepatic bile duct were stained for proliferating
cell nuclear antigen (PCNA). The PCNA labeling indexes of patients with these malformations were significantly higher than
those of patients without these malformations (P < 0.05). Cell proliferation of the epithelia in the biliary ductal system in patients with these congenital biliary malformations
was accelerated. Consequently, these congenital malformations appear to be an important risk factor for the occurrence of
biliary malignancy.
Received for publication on Feb. 15, 1999; accepted on March 29, 1999 相似文献
20.
Iwai N Fumino S Tsuda T Ono S Kimura O Deguchi E 《Journal of pediatric surgery》2004,39(12):1794-1796