胰胆管合流异常与先天性胆总管囊肿

目的:探讨胰胆管合流异常(PBM)致先天性胆总管囊肿(CCC)的可能机制。方法:将21例经B超诊断为胆总管囊肿患者行ERCP检查，检查时经选择性胆管插管抽取胆汁检测其中淀粉酶(AMS)及C反应蛋白(CRP)浓度。结果: 21例PBM均合并CCC，其中13例为胆管合流型(C-P型)，8例为胰管合流型(P-C型) PBM。21例胆汁中AMS及CRP浓度均较对照组显著升高(P<0.01)，C-P型较P-C型升高更明显(P<0.05)。 结论:PBM可能是CCC形成的解剖学基础，胰液返流至胆管，被激活的高浓度胰酶破坏胆管壁，则可能是CCC形成的促发因素。

Pancreaticobiliary maljunction and congenital choledochal cyst

Abstract:Objective:To investigate the possible mechanism of pancreaticobiliary maljunction (PBM) on development of congenital choledochal cyst (CCC).Methods :Tweenty-one patients with choledochal cysts initially diagnosed by ultrasonography, then underwent ERCP. The concentrations of amylase (AMS) and C-reactive protein (CRP) in bile removed through selective biliary catheterization was analyzed.Results:Each of 21 cases of PBM (including 13 cases of C-P type and 8 cases of P-C type) had significantly higher concentrations of AMS and CRP compared with control group (P<0.01). The elevations of AMS and CRP in C-P type were much higher than those in P-C type. (P<0.05).Conclusions: PBM was likely the anatomic foundation of CCC formation. However, the activated, highly concentrated pancreatic enzymes resulting from pancreatic juice reflux into the bile ducts can cause injury of the walls of bile ducts, and trigger CCC formation.