Yun Sung-Pil, Lee Jee Yeon, Jo Hong Jae, Kim Hyun Sung, Kim Dae Hwan, Kim Jae Hun, Park Sung Jin, Park Do Yoon, Seo Hyung-Il
Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
J Korean Surg Soc. 2013 Feb;84(2):101-6. doi: 10.4174/jkss.2013.84.2.101. Epub 2013 Jan 29.
The reflux of pancreatic enzymes into the biliary tract is associated with chronic inflammation and increases cellular proliferation of the biliary epithelium, leading to biliary carcinoma. The aim of this study is to detect the incidence of occult pancreaticobiliary reflux (OPBR) in patients who underwent elective cholecystectomy.
Forty-seven patients with symptomatic gallstones who underwent cholecystectomy were recruited for this study. The gallbladder bile samples were obtained from the specimen of gallbladder and the amylase level was measured. The immunohistochemistry of p53, SMAD4 and Ki-67 were performed for the detection of metaplasia and dysplasia.
Biliary amylase was higher than the serum amylase in 10 patients (group A, 15,402.66 ± 33,592.43 IU/L; group B, 13.06 ± 18.12 IU/L). The mean age was 67.2 years in group A and 51.2 in group B (P < 0.01). The ratio of male to female was 1:2.3 and 1:1.8 in group A and B, respectively (P = 0.297). Eight patients in group A and thirteen patients in group B had inflammation (P = 0.014). The positive results of the Ki-67 test were exhibited in five cases in each group (P = 0.024).
Results from the study indicate that the age was older, degree of inflammation and positive rate of Ki-67 were higher when OPBR was suspected. In conclusion, the patients with OPBR would need long-term follow-up, because the OPBR can cause dysplasia and the reflux of pancreatic juice may be considered as a risk factor for extrahepatic bile duct carcinoma.
胰腺酶反流至胆道与慢性炎症相关，并增加胆管上皮细胞增殖，进而导致胆管癌。本研究旨在检测接受择期胆囊切除术患者中隐匿性胰胆反流（OPBR）的发生率。
本研究招募了47例因有症状胆结石而接受胆囊切除术的患者。从胆囊标本中获取胆囊胆汁样本并测量淀粉酶水平。进行p53、SMAD4和Ki-67的免疫组化检测以发现化生和发育异常。
10例患者的胆汁淀粉酶高于血清淀粉酶（A组，15402.66±33592.43 IU/L；B组，13.06±18.12 IU/L）。A组平均年龄为67.2岁，B组为51.2岁（P<0.01）。A组和B组的男女比例分别为1:2.3和1:1.8（P=0.297）。A组8例患者和B组13例患者有炎症（P=0.014）。每组各有5例患者Ki-67检测结果呈阳性（P=0.024）。
研究结果表明，怀疑有OPBR时患者年龄较大，炎症程度和Ki-67阳性率较高。总之，OPBR患者需要长期随访，因为OPBR可导致发育异常，且胰液反流可能被视为肝外胆管癌的一个危险因素。
