Chijiiwa K, Tanaka M, Nakayama F
Department of Surgery 1, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Am Surg. 1993 Jul;59(7):430-4.
We have previously shown that an anomalous pancreaticobiliary ductal junction (APBDJ) is a risk factor for developing carcinoma of the gallbladder. However, the incidence of APBDJ in patients with primary carcinoma of the gallbladder has been little examined. Of 53 consecutive patients with gallbladder carcinoma, 37 patients had a direct cholangiography to allow satisfactory evaluation of the pancreaticobiliary ductal junction. Eleven per cent of these 37 patients had an associated APBDJ, which was significantly higher than the reported incidence of APBDJ in human (2%). Two of these four patients were associated with choledochal cyst and the other two were not. The main clinical differences in patients with gallbladder carcinoma associated with APBDJ and those without APBDJ were that the mean age of the former group was lower by about 10 years than the latter, and none had gallstones in the former while 54 per cent had gallstones in the latter group. The results show that APBDJ is a risk factor for developing carcinoma of the gallbladder earlier, and factors other than gallstone are more causative in patients with APBDJ. The frequent association with APBDJ should be kept in mind at the time of surgical treatment of the primary gallbladder carcinoma.
我们之前已经表明，胰胆管异常汇合（APBDJ）是胆囊癌发生的一个危险因素。然而，原发性胆囊癌患者中APBDJ的发生率鲜有研究。在连续的53例胆囊癌患者中，37例患者接受了直接胆管造影，以便对胰胆管汇合情况进行满意的评估。这37例患者中有11%伴有APBDJ，这显著高于报道的人类APBDJ发生率（2%）。这4例患者中有2例与胆总管囊肿有关，另外2例无关。伴有APBDJ的胆囊癌患者与不伴有APBDJ的患者的主要临床差异在于，前一组的平均年龄比后一组低约10岁，前一组无胆结石，而后一组有胆结石的比例为54%。结果表明，APBDJ是胆囊癌早期发生的一个危险因素，在伴有APBDJ的患者中，胆结石以外的因素更具病因性。在对原发性胆囊癌进行手术治疗时，应牢记其与APBDJ的频繁关联。
