胆囊上皮不典型增生与隐性胰胆反流

目的 评价隐性胰胆反流与胆囊癌变的关系.方法 检测340例择期胆囊切除术病人血液和胆囊胆汁淀粉酶确定隐性胰胆反流.组织病理学观察隐性胰胆反流胆囊标本的不典型增生发生率以及免疫组化观察胆囊黏膜上皮的增殖活性.结果 340例择期胆囊切除标本中隐性胰胆反流发生率为9.4%(32/340).32例隐性胰胆反流标本中发生胆囊癌1例.不典型增生11例.胆囊癌和不典型增生发生率为37.5%(12/32).对照组发生不典型增生发生率8.4%(26/308),两组差异有显著意义(P=0.006).隐性胰胆反流的胆囊上皮的Ki67指数平均为24.4%,高于对照组13.2%(P=0.014).结论 隐性胰胆反流是胆囊癌发生重要的诱因.

Development of epithelial dysplasia in gallbladder with occult pancreatobiliary reflux

Objective To investigate the role of occult pancreatobiliary reflux in gallbladder car-cinogenesis. Methods The blood amylase and gallbladder bile amylase were measured, respectively,to diagnosis the occult pancreatobiliary reflux in 340 patients receiving selective cholecystectomy. The dysplasia and the proliferation activity in mucosa of gallbladders were detected histopathologically and immunohistochemieally. Results The incidence of occult pancreatobiliary reflux was 9.4% (32/340). One case of carcinoma and 11 cases of dysplasia were found in the 32 gallbladders with occult pancre-atobiliary reflux. The incidence of carcinoma and dysplasia was 37.5% in gallbladders with occult pan-creatobiliary reflux, which was higher than the control group with dysplasia incidence of 8.4% (P=0.006). The average Ki67 index was 24.4% in gallbladders with occult pancreatobiliary reflux, which was higher than the control group with Ki67 index of 13.2% (P=0.014). Conclusion The occult pancreatobiliary reflux is an important factor to induce gallbladder cancer.