Kimura K, Ohto M, Saisho H, Unozawa T, Tsuchiya Y, Morita M, Ebara M, Matsutani S, Okuda K
Gastroenterology. 1985 Dec;89(6):1258-65. doi: 10.1016/0016-5085(85)90641-9.
A total of 96 patients with gallbladder carcinoma in whom direct cholangiography clearly opacified the pancreaticobiliary ductal union and the common channel, and 65 patients with an anomalous union of these two duct systems at a distance greater than 15 mm from the papilla of Vater (normally less than 4.6 +/- 2.2 mm, mean +/- SD) were studied. It was found that this anomalous ductal union occurred in 16.7% of the patients with gallbladder carcinoma in comparison with an incidence of 2.8% among 641 consecutive patients with various hepatobiliary and pancreatic diseases studied by endoscopic retrograde cholangiopancreatography who did not have gallbladder carcinoma. It was also found that gallbladder carcinoma occurred in 24.6% of the 65 cases of anomalous ductal union in comparison with a 1.9% incidence of this cancer among 635 consecutive patients similarly studied and found to have normal ductal union (p less than 0.001). Thus, a close etiologic association was suggested between this anomaly in the terminal segment of the biliary tract and gallbladder carcinoma. Of the 65 patients with anomalous ductal union, 50 had the so-called congenital cystic dilatation of the common bile duct and 15 did not. Five of the 50 (10%) and 11 of the 15 (73.3%) had gallbladder carcinoma (p less than 0.01), and this carcinoma seems to be related to anomalous ductal union rather than to cystic dilatation of the common bile duct. As a tumorigenic factor in this anomaly, regurgitation of pancreatic juice has been stressed.
对96例胆囊癌患者进行了研究，这些患者的直接胆管造影清晰显示了胰胆管汇合部和共同通道；还对65例这两个管道系统在距 Vater 乳头大于15mm处（正常情况下小于4.6±2.2mm，均值±标准差）发生异常汇合的患者进行了研究。结果发现，在胆囊癌患者中，这种异常胆管汇合的发生率为16.7%，而在641例接受内镜逆行胰胆管造影检查的、无胆囊癌的各种肝胆胰疾病连续患者中，该发生率为2.8%。还发现，在65例异常胆管汇合病例中，胆囊癌的发生率为24.6%，而在635例同样接受研究且发现胆管汇合正常的连续患者中，该癌症的发生率为1.9%（p<0.001）。因此，提示胆道末端段的这种异常与胆囊癌之间存在密切的病因学关联。在65例异常胆管汇合的患者中，50例有所谓的胆总管先天性囊性扩张，15例没有。50例中的5例（10%）和15例中的11例（73.3%）患有胆囊癌（p<0.01），而且这种癌症似乎与异常胆管汇合有关，而非与胆总管囊性扩张有关。作为这种异常情况中的一个致瘤因素，胰液反流受到了关注。
