Department of Surgery, Hospital San Juan de Dios de La Serena, Coquimbo, Chile.
Medicine School, Universidad de Santiago de Chile, Santiago, Chile.
J Hepatobiliary Pancreat Sci. 2021 May;28(5):443-449. doi: 10.1002/jhbp.931. Epub 2021 Mar 15.
The reflux of pancreatic enzymes into the bile duct and the gallbladder is an abnormal phenomenon that plays a role in lithogenesis and carcinogenesis. Because the pressure of the common bile duct depends on the pressures of the sphincter of Oddi, its dysfunction would be reflected in an increase in the pressure of the common bile duct in patients with cholelithiasis. The objective of this study was to measure the pressures of the common bile duct in patients with and without cholelithiasis and to relate them to the presence of pancreatobiliary reflux.
A prospective case-control study was designed. The study universe was constituted by all patients undergoing total gastrectomy for gastric cancer stages I and II over 30 months. The primary outcome measure was to establish differences between common bile duct pressures in patients with and without cholelithiasis.
Common bile duct pressures in patients with gallstones showed a significant elevation (16.9 mmHg) compared to patients without gallstones (3.3 mm Hg) (p < 0.0001). These pressures correlated with the levels of amylase and lipase in gallbladder bile; higher levels were found in patients with gallstones compared to patients without gallstones (P < 0.0001).
Common bile duct pressure in patients with cholelithiasis was significantly higher compared to patients without cholelithiasis leading to pancreatobiliary reflux.
胰酶反流入胆管和胆囊是一种异常现象，在结石形成和癌变中起作用。由于胆总管的压力取决于 Oddi 括约肌的压力，因此其功能障碍将反映在胆结石患者的胆总管压力增加。本研究的目的是测量有和没有胆结石的患者的胆总管压力，并将其与胰胆反流的存在相关联。
设计了一项前瞻性病例对照研究。研究范围由 30 个月内接受 I 期和 II 期胃癌全胃切除术的所有患者组成。主要观察指标是确定有和没有胆结石的患者胆总管压力之间的差异。
胆结石患者的胆总管压力（16.9mmHg）明显高于无胆结石患者（3.3mmHg）（p<0.0001）。这些压力与胆囊胆汁中淀粉酶和脂肪酶的水平相关；胆结石患者的水平高于无胆结石患者（P<0.0001）。
与无胆结石患者相比，胆结石患者的胆总管压力明显升高，导致胰胆反流。
