Xiang Y K, Zhang C, Yang Y L, Hu H, Huang A H, Zhao G, Cai J L, Xu A A, Tian F Z, Qiu C, Kong X Y, Da X B, Lyu B N, Zhang H L
Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, School of Medicine, Tongji University, Shanghai 200120, China.
General Surgery Center of the Western Theater General Hospital, Chengdu 610083, China.
Zhonghua Yi Xue Za Zhi. 2023 Apr 25;103(16):1230-1235. doi: 10.3760/cma.j.cn112137-20220831-01843.
To explore the association between gallbladder adenomyomatosis (GA) and occult pancreaticobiliary reflux (OPBR). A total of 81 patients with GA who underwent cholecystectomy in Shanghai East Hospital from December 2020 to January 2022 were enrolled, including 48 cases of fundal type, 28 cases of segmental type and 5 cases of diffuse type. Patient's intraoperative bile was coltected and tested for amylase. According to gallbladder bile amylase level, patients were divided into OPBR group (bile amylase>110 U/L) and the control group (bile amylase≤110 U/L). Among 81 patients, 32 were male and 49 were female, and aged (49.1±13.2) years; there were 66 cases in control group, including 27 males and 39 females, and aged (50.0±12.9)years; there were 15 patients in the OPBR group, including 5 males and 10 females, and aged (45.1±14.2) years. In terms of the clinical features of the two groups, there was no significant difference (all >0.05), except for a significant increase in biliary amylase in the OPBR group compared with the control group (<0.001). However, the incidence of OPBR was significantly different in the three types of GA, with a lower incidence of OPBR in the fundal type (10.4%, 5/48) than in the segmental type (28.6%, 8/28) and diffuse type (2/5) (=0.038). In addition, segmental GA was more likely to be combined with gallbladder stones (85.7%, 24/28) than fundal GA (58.3%, 28/48) and diffuse GA (3/5) (=0.031). Univariate and multivariate logistic regression analyses showed OPBR [ (95%)=3.410 (1.010 to 11.513), =0.048] and combined gallbladder stones [ (95%)=2.974 (1.011 to 8.745), =0.048] indepenclently correlated with segmental and diffuse GA. The incidence of OPBR is higher in segmental and diffuse GA, and gallstones and OPBR are independently associated with the occurrence of segmental and diffuse GA. These results suggest that OPBR may be the initiating factor for the occurrence and carcinogenesis of segmental and diffuse GA.
探讨胆囊腺肌症（GA）与隐匿性胰胆管反流（OPBR）之间的关联。纳入2020年12月至2022年1月在上海东方医院接受胆囊切除术的81例GA患者，其中基底型48例，节段型28例，弥漫型5例。收集患者术中胆汁并检测淀粉酶。根据胆囊胆汁淀粉酶水平，将患者分为OPBR组（胆汁淀粉酶>110 U/L）和对照组（胆汁淀粉酶≤110 U/L）。81例患者中，男性32例，女性49例，年龄（49.1±13.2）岁；对照组66例，其中男性27例，女性39例，年龄（50.0±12.9）岁；OPBR组15例，其中男性5例，女性10例，年龄（45.1±14.2）岁。两组临床特征比较，差异均无统计学意义（均>0.05），但OPBR组胆汁淀粉酶水平显著高于对照组（<0.001）。然而，OPBR在GA三种类型中的发生率差异有统计学意义，基底型OPBR发生率（10.4%，5/48）低于节段型（28.6%，8/28）和弥漫型（2/5）（=0.038）。此外，节段型GA比基底型GA（58.3%，28/48）和弥漫型GA（3/5）更易合并胆囊结石（85.7%，24/28）（=0.031）。单因素和多因素logistic回归分析显示，OPBR[比值比（95%置信区间）=3.410（1.010至11.513），P=0.048]和合并胆囊结石[比值比（95%置信区间）=2.974（1.011至8.745），P=0.048]与节段型和弥漫型GA独立相关。节段型和弥漫型GA中OPBR发生率较高，胆囊结石和OPBR与节段型和弥漫型GA的发生独立相关。这些结果提示，OPBR可能是节段型和弥漫型GA发生及癌变的起始因素。
