Suda K, Miyano T, Suzuki F, Matsumoto M, Yamashiro Y, Tokumaru T, Oyama T, Matsumoto Y
Department of Pathology, Yamanashi Medical University, Japan.
Acta Pathol Jpn. 1987 Oct;37(10):1549-62. doi: 10.1111/j.1440-1827.1987.tb02466.x.
An abnormal pancreatico-choledocho-ductal junction, in which free communication between the pancreatic duct and the common bile duct was present, was observed in 17 out of 120 cases (14.2%) of biliary tract carcinoma and in all of four cases of congenital biliary dilatation, but in noe of about 200 control patients without biliary tract disease. Outstanding findings in the pancreas, such as degeneration of the ductal epithelium and interlobular fibrosis, were found in 6 of 21 cases of abnormal junction. In an experimental study using 63 puppies given choledocho-pancreatic end-to-side ductal anastomosis, dilatation of the bile duct of varying degree occurred and mucosal hyperplasia of the biliary tract was observed in 12 of 25 anastomosed dogs for a duration of more than one month. Cell kinetics in biliary tract mucosa observed by the use of monoclonal antibody against bromodeoxyuridine (BrdU) was obviously elevated in dogs subject to long-term follow-up. As for pancreatic lesions, the incidence and histologic findings were similar to those of human studies, as follows: chronic pancreatitis in only a few animals, mild periductal parenchymatous change in 15 puppies and no significant change in 44 puppies. Therefore, an abnormal pancreatico-choledocho-ductal junction may be one of the significant factors producing biliary dilatation, biliary tract carcinoma and pancreatitis.
在120例胆管癌患者中，有17例（14.2%）观察到胰胆管连接异常，即胰管与胆总管之间存在自由交通；在4例先天性胆管扩张患者中均观察到这种情况，但在约200例无胆道疾病的对照患者中均未发现。在21例连接异常的病例中，有6例胰腺出现显著病变，如导管上皮变性和小叶间纤维化。在一项对63只幼犬进行胆总管-胰管端侧吻合的实验研究中，25只接受吻合的犬中有12只在术后一个多月出现不同程度的胆管扩张，并观察到胆道黏膜增生。通过使用抗溴脱氧尿苷（BrdU）单克隆抗体观察到，长期随访的犬胆道黏膜细胞动力学明显升高。至于胰腺病变，其发生率和组织学表现与人体研究相似，具体如下：只有少数动物出现慢性胰腺炎，15只幼犬出现轻度导管周围实质改变，44只幼犬无明显变化。因此，胰胆管连接异常可能是导致胆管扩张、胆管癌和胰腺炎的重要因素之一。
