Komi N, Takehara H, Kunitomo K, Miyoshi Y, Yagi T
First Department of Surgery, School of Medicine, University of Tokushima, Japan.
J Pediatr Surg. 1992 Jun;27(6):728-31. doi: 10.1016/s0022-3468(05)80102-2.
A new classification of the anomalous arrangement of pancreaticobiliary ducts (APBD) has been proposed following amendments and modificiations of the previous one. Fifty-one cases of choledochal cyst complicated with APBD were extensively examined and analyzed for clear visualization of the APBD system to make a standard classification. APBD were classified broadly into three types: type I, type II, and type III with their subtypes. Type I of APBD was seen in 18 (35.3%), type II in 11 (21.6%) and type III in 22 (43.1%) cases, respectively. A radical operation, including complete excision of the dilated biliary duct followed by reconstruction of the biliary tract was the surgical treatment of choice, because the reflux of the pancreatic juice into the biliary tract is prevented. However, a dilated common channel or accessory pancreatic duct, according to the new Komi type Ib, IIb, and IIIc3 of APBD, could be the cause of relapsing pancreatitis leading to chronic pancreatitis, due to the formation of a protein plug or pancreatic calculus in the dilated duct, even after this radical operation. In two complicated cases of type IIIc3 of APBD in choledochal cyst, we performed a pylorus-preserving pancreatoduodenectomy as one of the operative methods of choice. Long-term follow-up, more than decades, is essential to evaluate the results of surgical procedure for choledochal cyst, especially in those complicated cases with type Ib, IIb, and IIIc3 of APBD according to the new Komi's classification.
在对先前的胰胆管异常排列（APBD）分类进行修订和完善后，提出了一种新的分类方法。对51例胆总管囊肿合并APBD的病例进行了广泛检查和分析，以清晰显示APBD系统，从而制定标准分类。APBD大致分为三种类型：I型、II型和III型及其亚型。APBD的I型见于18例（35.3%），II型见于11例（21.6%），III型见于22例（43.1%）。手术治疗的首选方法是根治性手术，包括完全切除扩张的胆管，随后重建胆道，因为这样可以防止胰液反流至胆道。然而，根据新的APBD Komi Ib型、IIb型和IIIc3型，扩张的共同通道或副胰管可能是复发性胰腺炎导致慢性胰腺炎的原因，因为即使在这种根治性手术后，扩张的导管中仍会形成蛋白栓或胰石。在两例胆总管囊肿合并APBD IIIc3型的复杂病例中，我们实施了保留幽门的胰十二指肠切除术作为首选手术方法之一。对胆总管囊肿手术结果的评估，尤其是根据新的Komi分类法对合并Ib型、IIb型和IIIc3型APBD的复杂病例进行评估，进行数十年以上的长期随访至关重要。
