Purvis N S, Mirjalili S A, Stringer M D
Department of Anatomy, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin, New Zealand.
Surg Radiol Anat. 2013 Dec;35(10):943-50. doi: 10.1007/s00276-013-1128-y. Epub 2013 May 5.
The structure and function of the mucosal folds in the terminal bile and pancreatic ducts and hepatopancreatic ampulla are poorly characterised. The distribution, muscularity, and innervation of these folds were investigated.
The pancreaticobiliary junction was excised from ten cadavers (five male, 66-90 years) and examined histologically by serially sectioning (4-μm thickness) along the length of the terminal bile and pancreatic ducts from the tip of the major duodenal papilla. Three surgical specimens (two male, 63-72 years) were also evaluated. Sections were stained with haematoxylin and eosin, anti-actin (smooth muscle), anti-S100 (innervation), and anti-cholecystokinin (CCK)-A receptor antibodies. ImageJ software was used to compare relative radial fold projection and semi-quantitatively assess the smooth muscle and nerve content. In one additional cadaver specimen, folds were examined by scanning electron microscopy.
Mucosal folds in the terminal bile duct were arranged circumferentially in a lattice-like arrangement and were distributed over an average distance of 7.3 mm along the terminal bile duct compared to 4.2 mm along the pancreatic duct (P = 0.001), projected further into the lumen, and were more densely innervated than those in the terminal pancreatic duct. Folds in both ducts contained smooth muscle which was more prominent in folds nearest to the major duodenal papilla. Mucosal folds in cadaver and surgical specimens showed no evidence of CCK-A receptor immunoreactivity.
This study demonstrates that the mucosal folds of the terminal bile and pancreatic ducts contain muscle and nerve fibres, suggesting an active rather than purely passive function.
肝胰管末端和肝胰壶腹中黏膜皱襞的结构和功能特征尚不明确。本研究对这些皱襞的分布、肌层和神经支配进行了研究。
从10具尸体（5例男性，年龄66 - 90岁）上切除胰胆管交界处，沿十二指肠大乳头尖端的肝胰管末端纵向连续切片（厚度4μm）进行组织学检查。还评估了3份手术标本（2例男性，年龄63 - 72岁）。切片用苏木精和伊红、抗肌动蛋白（平滑肌）、抗S100（神经支配）和抗胆囊收缩素（CCK）-A受体抗体染色。使用ImageJ软件比较相对径向皱襞投影，并半定量评估平滑肌和神经含量。在另外1具尸体标本中，通过扫描电子显微镜检查皱襞。
肝胰管末端的黏膜皱襞呈圆周状排列成网格状，沿肝胰管末端平均分布距离为7.3mm，而沿胰管为4.2mm（P = 0.001），向管腔内突出更远，且神经支配比胰管末端的皱襞更密集。两个管道中的皱襞均含有平滑肌，在最靠近十二指肠大乳头的皱襞中更明显。尸体和手术标本中的黏膜皱襞均未显示CCK - A受体免疫反应性。
本研究表明，肝胰管末端的黏膜皱襞含有肌肉和神经纤维，提示其具有主动而非单纯被动的功能。
