Ohta T, Nagakawa T, Ueno K, Maeda K, Ueda N, Kayahara M, Akiyama T, Kanno M, Konishi I, Izumi R
Second Department of Surgery, School of Medicine, Kanazawa University, Japan.
Jpn J Surg. 1990 Jan;20(1):36-43. doi: 10.1007/BF02470711.
Between 1978 and 1988, 15 patients with gallbladder cancer and 2 patients with bile duct cancer were seen among 49 patients with anomalous union of the pancreaticobiliary ductal system. Radiographic findings revealed two types of this anomalous condition: one in which the pancreatic duct entered the common bile duct (type 1) and one in which the common bile duct entered the pancreatic duct (type 2). In gallbladder cancer, the common bile duct presented no dilatation, or in some patients, mild dilatation, and type-1 anomalous union was frequently found among these patients. In contrast, the two patients with bile duct cancer had cystic dilatation of the common bile duct and type-2 anomalous union. The bile amylase level, which was determined in seven patients, was extremely high in all the patients. Histopathologically, the tumors in most patients showed papillary to papillo-tubular proliferation in the mucosal layer while atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that this congenital anomaly in both ducts results in a loss of the normal sphincteric mechanism of the duodenal papilla, and that chronic relapsing cholecystitis or cholangitis, caused by the reflux of pancreatic juice into the biliary tract, can induced progressive changes to atypical epithelial hyperplasia which may develop into carcinoma.
1978年至1988年间，在49例胰胆管系统异常汇合的患者中，发现15例胆囊癌患者和2例胆管癌患者。影像学检查结果显示这种异常情况有两种类型：一种是胰管汇入胆总管（1型），另一种是胆总管汇入胰管（2型）。在胆囊癌患者中，胆总管未出现扩张，或在部分患者中仅有轻度扩张，且这些患者中经常发现1型异常汇合。相比之下，2例胆管癌患者的胆总管呈囊性扩张，且为2型异常汇合。7例患者的胆汁淀粉酶水平测定结果显示，所有患者的该水平均极高。组织病理学检查显示，大多数患者的肿瘤在黏膜层呈乳头状至乳头管状增生，而在肿瘤区域附近可见非典型上皮增生。这些发现表明，这两种导管的先天性异常导致十二指肠乳头正常括约肌机制丧失，且胰液反流至胆道引起的慢性复发性胆囊炎或胆管炎可诱发非典型上皮增生的进行性改变，进而可能发展为癌。
