Matsumoto Y, Fujii H, Itakura J, Mogaki M, Matsuda M, Morozumi A, Fujino M A, Suda K
First Department of Surgery, Yamanashi Medical University, Tamaho, Japan.
Gastrointest Endosc. 2001 May;53(6):614-9. doi: 10.1067/mge.2001.113920.
The purpose of this study was to develop a new concept of the embryonic etiology of pancreaticobiliary maljunction (PBM) based on cholangiopancreatograms.
The subjects were 202 patients with PBM (60 men and 142 women) in whom the junction of the pancreatic and bile ducts was radiologically diagnosed as being located outside of the duodenal wall; 133 of the 202 patients also had congenital cystic dilatation of the bile duct (CCBD).
The length of the duct from the junction to the orifice of the major papilla (the common channel) ranged from 0.5 to 5 cm on the cholangiopancreatograms. Small radicles of the pancreatic duct arose from the common channel in 36 of the 202 patients. This finding suggests that the common channel is itself the main pancreatic duct in patients with PBM. Moreover, cholangiopancreatography revealed that in 99 of the 202 patients, there was a narrowed duct segment distal to the biliary cyst in patients with CCBD or distal to the normal bile duct in those without CCBD; the length of the narrowed segment varied. Histologic examination revealed smaller branches that had arisen from this narrowed segment in 2 anatomic specimens. This also suggests that the narrowed ductal segment belongs to the pancreatic duct system.
PBM is an anomaly that is probably caused by a disturbance in the embryologic connections (misarrangement) of the pancreatic and biliary duct system that occurs extremely early during gestation when the bile duct joins with the ventral pancreatic duct system. PBM is not due to an arrest of the normal migration of the common channel into the duodenal lumen during embryonic development.
本研究旨在基于胆管胰管造影术提出一种关于胰胆管合流异常（PBM）胚胎病因的新概念。
研究对象为202例PBM患者（60例男性和142例女性），经放射学诊断胰管和胆管的汇合处位于十二指肠壁外；202例患者中有133例还患有先天性胆管囊肿扩张（CCBD）。
在胆管胰管造影图上，从汇合处到主乳头开口（共同通道）的导管长度为0.5至5厘米。202例患者中有36例胰管小分支起源于共同通道。这一发现表明，共同通道本身就是PBM患者的主要胰管。此外，胆管胰管造影显示，202例患者中有99例，在患有CCBD的患者中，胆管囊肿远端或无CCBD的患者中正常胆管远端存在导管狭窄段；狭窄段长度各不相同。组织学检查显示，在2个解剖标本中，有较小的分支起源于这个狭窄段。这也表明狭窄的导管段属于胰管系统。
PBM是一种异常情况，可能是由于在妊娠早期胆管与腹侧胰管系统汇合时，胰胆管系统的胚胎连接受到干扰（排列错误）所致。PBM并非由于胚胎发育过程中共同通道向十二指肠腔内的正常迁移受阻。
