Horaguchi Jun, Fujita Naotaka, Kamisawa Terumi, Honda Goro, Chijiiwa Kazuo, Maguchi Hiroyuki, Tanaka Masao, Shimada Mitsuo, Igarashi Yoshinori, Inui Kazuo, Hanada Keiji, Itoi Takao, Hamada Yoshinori, Koshinaga Tsugumichi, Fujii Hideki, Urushihara Naoto, Ando Hisami
Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, Miyagi, 983-0824, Japan,
J Gastroenterol. 2014 May;49(5):875-81. doi: 10.1007/s00535-013-0837-7. Epub 2013 Jun 5.
Pancreatobiliary reflux (PBR) can occur in individuals without pancreaticobiliary maljunction. The aim of this study was to elucidate the incidence of PBR in individuals with a normal pancreaticobiliary junction and its impact on the biliary tree.
Data were prospectively collected from 15 centers on 420 patients with a morphologically normal pancreaticobiliary junction who had undergone bile sampling and measurement of the biliary amylase level. We investigated the incidence and predictive factors for high biliary amylase levels (HBAL), as well as the relationship of HBAL with biliary malignancy.
Twenty-three patients (5.5%) showed HBAL (≥10,000 IU/L). Univariate analysis showed that risk factors for the elevation of biliary amylase levels were the existence of a relatively long common channel (≥5 mm), acute pancreatitis, and papillitis. Multivariate analysis revealed that only the existence of a relatively long common channel was a significant factor for PBR. Biliary amylase levels in patients with a relatively long common channel were significantly higher than in patients without a long common channel (12,333 vs. 2,070 IU/L, P = 0.001). The incidence of HBAL (P < 0.001), as well as the overall biliary amylase levels (P = 0.007) were significantly higher in patients with gallbladder cancer than in those without gallbladder cancer.
The PBR was frequently observed in individuals with a relatively long common channel. Patients showing HBAL with normal pancreaticobiliary junction are at high risk for gallbladder cancer.
胰胆反流（PBR）可发生于无胰胆连接异常的个体。本研究的目的是阐明胰胆连接正常个体中PBR的发生率及其对胆道系统的影响。
前瞻性收集来自15个中心的420例胰胆连接形态正常且已进行胆汁采样和胆汁淀粉酶水平测量的患者的数据。我们调查了高胆汁淀粉酶水平（HBAL）的发生率和预测因素，以及HBAL与胆道恶性肿瘤的关系。
23例患者（5.5%）出现HBAL（≥10,000 IU/L）。单因素分析显示，胆汁淀粉酶水平升高的危险因素包括存在相对较长的共同通道（≥5 mm）、急性胰腺炎和乳头炎。多因素分析显示，只有存在相对较长的共同通道是PBR的显著因素。存在相对较长共同通道的患者胆汁淀粉酶水平显著高于无长共同通道的患者（12,333 vs. 2,070 IU/L，P = 0.001）。胆囊癌患者中HBAL的发生率（P < 0.001）以及总体胆汁淀粉酶水平（P = 0.007）均显著高于无胆囊癌的患者。
在存在相对较长共同通道的个体中经常观察到PBR。胰胆连接正常但出现HBAL的患者患胆囊癌的风险较高。
