Imazu M, Iwai N, Tokiwa K, Shimotake T, Kimura O, Ono S
Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Japan.
Eur J Pediatr Surg. 2001 Feb;11(1):24-7. doi: 10.1055/s-2001-12190.
The long-term complications of choledochal cysts include malignant degeneration of the epithelial lining of the biliary tract. Possible factors leading to malignant degeneration were examined by measuring amylase levels in the biliary tract, intraoperative biliary manometry and a histopathological study. 27 patients, 1 to 13 years of age, with choledochal cysts, were studied over a 13-year period. Amylase levels in the bile of choledochal cysts and the gallbladder were measured. The pressure profile of the biliary tract was recorded as the probe was withdrawn from the sphincter of Oddi (SO) to the distal end of the common bile duct. Hyperplasia of the gallbladder mucosa and malignancy of the biliary tract were investigated. Patients with high levels of biliary amylase had higher pressure differences between the SO and the duodenum than those with low levels of biliary amylase. The incidence of mucosal hyperplasia of the gallbladder mucosa was significantly higher in the fusiform type than in the cystic type. Adenocarcinoma in a cystic choledochal dilatation was found in a 12-year-old girl with high amylase levels. The cause of regurgitation of pancreatic juice into the biliary system might be due to a high pressure difference between the SO and the duodenum in addition to the lack of sphincter function at the abnormal junction of the pancreaticobiliary ductal system. Early diagnosis and surgical treatment to prevent the regurgitation leading to hyperplasia and malignancy of the biliary tract are important for children with choledochal cysts.
胆总管囊肿的长期并发症包括胆道上皮衬里的恶性变。通过测量胆道中的淀粉酶水平、术中胆道测压和组织病理学研究，对导致恶性变的可能因素进行了检查。在13年的时间里，对27例年龄在1至13岁之间的胆总管囊肿患者进行了研究。测量了胆总管囊肿和胆囊胆汁中的淀粉酶水平。当探头从Oddi括约肌（SO）撤回至胆总管远端时，记录胆道的压力曲线。研究了胆囊黏膜增生和胆道恶性肿瘤情况。胆道淀粉酶水平高的患者，其SO与十二指肠之间的压力差高于胆道淀粉酶水平低的患者。梭形类型的胆囊黏膜增生发生率明显高于囊性类型。在一名12岁、淀粉酶水平高的女孩的胆囊胆总管扩张中发现了腺癌。胰液反流至胆道系统的原因，除了胰胆管系统异常连接处缺乏括约肌功能外，可能还由于SO与十二指肠之间存在高压差。对于胆总管囊肿患儿，早期诊断和手术治疗以防止反流导致胆道增生和恶性变很重要。
