先天性胆总管囊肿胰胆合流共同管开口位置及其相关因素的分析研究

目的 探讨胰胆合流共同管开口异位及其相关因素在胆总管囊肿发病机制中的作用。方法 对116例显影清晰的先天性胆总管囊肿患者的ERCP或术中胆道造影的正位X线片进行有关数据的测量分析，并以6例遗传性球形红细胞增多症及7例新生儿肝炎综合征患儿胆道造影的X线片作为对照组，对测量数据进行统计学处理并加以比较。结果 对照组Vater壶腹均开口于十二指肠降段，而实验组开口于十二指肠降段者占31．1％，开口于降段以远者占68．9％，且共同管开口位置越远，共同管、胆总管越长，胰管直径及胰胆汇合角度越大。囊肿型囊肿的胆总管直径与长度及胰胆汇合角度与梭型比较，差异有非常显著性意义，且前者合并胰腺分离及其它肝内外胆管畸形的发生率明显增高。结论 影像学测量下，Vater壶腹开口异位的存在有可能是先天性胆总管囊肿的发病原因，而胰胆合流异常、胆总管远端狭窄及肝内胆管的畸形则是本病通常并发的病理改变，但也可能互为因果，有待进一步研究。

Analysis of locations and their related factors of common channel in congenital biliary dilatation with pancreatiobiliary malunion

Objective To investigate the relationship between the abdominal location of the papilla of Vater and the development of congenital biliary dilatation (CBD). Methods A total of 116 patients with CBD were studied through analysis of the data obtained from ERCP or intraoperative cholangiography. Six cases of hereditary spherocytosis and 7 cases of neonatal hepatitis were employed to serve as the controls. All data were statistically analyzed. Results In all the controls, the papilla of Vater located in the middle portion of the descending duodenum. Of the 116 patients, 31 1% had the papilla of Vater locating in the descending part of the duodenum and 68 9% had the papilla distal to the junction of the descending and transverse parts of the duodenum. Proportionally, the more distal the location of the papilla, the longer the common channel and the common bile duct, the larger the diameter of pancreatic duct, and the bigger the pancreaticobiliary angle. The length, diameter of the common bile duct and pancreaticobiliary angle in CBD of cystic type was significantly larger than that of fusiform type. Meanwhile, there was higher incidence of pancreatic division and malformation of intrahepatic ducts in the former. Conclusions Ectopic distal outgrowth of the hepatic diverticulum during early embryonic development may be an important etiological factor for CBD, whereas pancreaticobiliary malunion, distal stenosis of the common bile duct and malformation of intrahepatic ducts are the secondary pathological changes in CBD. However, it should further studied.