Kamisawa Terumi, Anjiki Hajime, Egawa Naoto, Kurata Masanao, Honda Goro, Tsuruta Kouji
World J Gastroenterol. 2008 Nov 21;14(43):6622-6. doi: 10.3748/wjg.14.6622.
The sphincter of Oddi is located at the distal end of the pancreatic and bile ducts and regulates the outflow of bile and pancreatic juice. A common channel can be so long that the junction of the pancreatic and bile ducts is located outside of the duodenal wall, as occurs in pancreaticobiliary maljunction (PBM); in such cases, sphincter action does not functionally affect the junction. As the hydropressure within the pancreatic duct is usually greater than in the bile duct, pancreatic juice frequently refluxes into the biliary duct (pancreatobiliary reflux) in PBM, resulting in carcinogenetic conditions in the biliary tract. Pancreatobiliary reflux can be diagnosed from elevated amylase level in the bile, secretin-stimulated dynamic magnetic resonance cholangiopancreatography, and pancreatography via the minor duodenal papilla. Recently, it has become obvious that pancreatobiliary reflux can occur in individuals without PBM. Pancreatobiliary reflux might be related to biliary carcinogenesis even in some individuals without PBM. Since few systemic studies exist with respect to clinical relevance and implications of the pancreatobiliary reflux in individuals with normal pancreaticobiliary junction, further prospective clinical studies including appropriate management should be performed.
奥迪括约肌位于胰管和胆管的远端，调节胆汁和胰液的流出。共同通道可能很长，以至于胰管和胆管的汇合处位于十二指肠壁外，如胰胆管合流异常（PBM）时的情况；在这种情况下，括约肌的作用在功能上不会影响汇合处。由于胰管内的液压通常高于胆管内的液压，在PBM中胰液经常反流至胆管（胰胆管反流），导致胆道出现致癌情况。胰胆管反流可通过胆汁中淀粉酶水平升高、促胰液素刺激的动态磁共振胰胆管造影以及经十二指肠小乳头的胰管造影来诊断。最近，很明显在没有PBM的个体中也会发生胰胆管反流。即使在一些没有PBM的个体中，胰胆管反流也可能与胆道致癌有关。由于关于胰胆管连接正常的个体中胰胆管反流的临床相关性和影响的系统性研究很少，因此应开展包括适当管理在内的进一步前瞻性临床研究。
