Tanno S, Obara T, Maguchi H, Mizukami Y, Shudo R, Fujii T, Takahashi K, Nishino N, Arisato S, Saitoh Y, Ura H, Kohgo Y
Third Department of Internal Medicine, Asahikawa Medical College, Hokkaido, Japan.
Gastrointest Endosc. 1997 Dec;46(6):520-6. doi: 10.1016/s0016-5107(97)70007-5.
An anomalous pancreaticobiliary ductal union (APBD) is a high-risk factor for biliary tract carcinoma, which often is not diagnosed before overt malignancy. The early detection of APBD is therefore clinically important. We evaluated the gallbladder wall in APBD patients with endoscopic ultrasonography.
Clinicopathologic features and ultrasonographic findings of the gallbladder in 33 consecutive patients with APBD between 1986 and 1995 were studied in relation to two subtypes of APBD, that is, undilated (n = 17) and dilated (n = 16). The gallbladder wall was evaluated with conventional ultrasonography and/or endoscopic ultrasonography. Histologic examinations of 25 resected gallbladders were made.
Fourteen of the seventeen patients with undilated type APBD (82%) had diffuse thickened gallbladder wall of 4 mm or more, whereas 5 of the 16 with dilated type (31%) had this finding (p < 0.01). The thickened gallbladder wall consisted sonographically of two layers: diffuse thickened inner hypoechoic layer and outer hyperechoic layer. Mucosal hyperplasia was histologically found in 8 of 9 cases (89%) with thickened inner hypoechoic layer on endoscopic ultrasonography. Mucosal hyperplasia was observed in 10 of 11 undilated type APBD cases (91%) in which cholecystectomy was performed. In addition, the presence of anomalous union was shown by endoscopic ultrasonography in 9 of 11 patients with undilated type APBD (82%) and all 7 of those with dilated type. The characteristic ultrasonographic pattern of diffuse thickened inner hypoechoic layer was observed exclusively in patients with mucosal hyperplasia of the gallbladder associated with APBD among 2085 endoscopic ultrasonography examinations performed during the study period.
Diffuse thickened inner hypoechoic layer of the gallbladder wall was frequently observed in APBD patients, especially those with the undilated type, on ultrasonography and/or endoscopic ultrasonography. This finding corresponded histologically to mucosal hyperplasia of the gallbladder mucosa. Thickened inner hypoechoic layer is a useful ultrasonographic sign that indicates mucosal hyperplasia of the gallbladder and, particularly, the possible coexistence of undilated type APBD before the appearance of overt malignancy.
胰胆管汇合异常（APBD）是胆道癌的高危因素，在明显恶变之前通常难以诊断。因此，APBD的早期检测具有重要的临床意义。我们采用内镜超声对APBD患者的胆囊壁进行了评估。
对1986年至1995年间连续收治的33例APBD患者的胆囊临床病理特征和超声检查结果进行了研究，将其分为两种APBD亚型，即未扩张型（n = 17）和扩张型（n = 16）。采用传统超声和/或内镜超声对胆囊壁进行评估。对25例切除的胆囊进行了组织学检查。
17例未扩张型APBD患者中有14例（82%）胆囊壁弥漫性增厚达4mm或更厚，而16例扩张型患者中有5例（31%）有此表现（p < 0.01）。增厚的胆囊壁在超声上表现为两层：弥漫性增厚的内层低回声层和外层高回声层。在内镜超声检查中，9例内层低回声层增厚的病例中有8例（89%）组织学上发现黏膜增生。在11例接受胆囊切除术的未扩张型APBD病例中有10例（91%）观察到黏膜增生。此外，内镜超声显示11例未扩张型APBD患者中有9例（82%）以及所有7例扩张型患者存在汇合异常。在研究期间进行的2085例内镜超声检查中，仅在与APBD相关的胆囊黏膜增生患者中观察到弥漫性增厚的内层低回声层这一特征性超声表现。
在超声和/或内镜超声检查中，APBD患者，尤其是未扩张型患者，常可见胆囊壁内层弥漫性增厚的低回声层。这一表现与胆囊黏膜的组织学增生相对应。增厚的内层低回声层是一种有用的超声征象，提示胆囊黏膜增生，特别是在明显恶变出现之前可能并存未扩张型APBD。
