Kobayashi S, Asano T, Yamasaki M, Kenmochi T, Saigo K, Ochiai T
Second Department of Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8670, Japan.
Arch Surg. 2001 Jul;136(7):759-63. doi: 10.1001/archsurg.136.7.759.
Pancreaticobiliary maljunction (PBM) is a high-risk factor for biliary tract carcinogenesis because of a continuous reflux of pancreatic juice into the biliary tract. It remains to be disclosed whether we should perform prophylactic excision of gallbladders and bile ducts.
A person-year method.
A university hospital.
We studied 68 patients with PBM treated between August 1, 1974, and December 31, 1999.
Relative risks (observed number-expected number ratios) of gallbladder and bile duct carcinomas according to type of bile duct dilation (ie, cystic dilation, diffuse dilation, and nondilation).
Observed number-expected number ratios of gallbladder carcinomas were high: 291.3 in 43 patients with cystic dilation, 167.2 in 16 patients with diffuse dilation, and 419.6 in 7 patients with nondilation. Observed number-expected number ratios of bile duct carcinomas were 194.2 in 43 patients with cystic dilation before surgery and 142.8 in 39 patients with cystic dilation after long postsurgical follow-up. All these values were statistically significant (P<.01).
The gallbladder carries a high risk for carcinogenesis in all types of dilation in patients with PBM. The bile duct carcinomas of PBM were exclusively identified by the type of cystic dilation. Prophylactic cholecystectomy should be recommended for all dilation types, and prophylactic excision of bile ducts including cholecystectomy should be performed in patients with PBM and cystic dilation. Complete excision of extrahepatic dilated bile ducts and careful follow-up for carcinogenesis in residual dilated bile ducts should be recommended for patients with PBM and cystic dilation.
胰胆管合流异常（PBM）是胆道致癌的高危因素，因为胰液持续反流至胆道。是否应进行胆囊和胆管的预防性切除仍有待揭示。
人年法。
一家大学医院。
我们研究了1974年8月1日至1999年12月31日期间接受治疗的68例PBM患者。
根据胆管扩张类型（即囊性扩张、弥漫性扩张和无扩张）计算胆囊癌和胆管癌的相对风险（观察数与预期数之比）。
胆囊癌的观察数与预期数之比很高：43例囊性扩张患者为291.3，16例弥漫性扩张患者为167.2，7例无扩张患者为419.6。术前43例囊性扩张患者胆管癌的观察数与预期数之比为194.2，术后长期随访的39例囊性扩张患者为142.8。所有这些值均具有统计学意义（P<0.01）。
在PBM患者中，所有类型的扩张情况下胆囊都有很高的致癌风险。PBM的胆管癌仅通过囊性扩张类型来识别。对于所有扩张类型均应建议进行预防性胆囊切除术，对于PBM和囊性扩张患者应进行包括胆囊切除术在内的胆管预防性切除。对于PBM和囊性扩张患者，应建议完全切除肝外扩张胆管，并对残留扩张胆管的癌变进行仔细随访。
