隐性胰胆反流75例分析  

Occult pancreatobiliary reflux

作　　者：钟征翔[1] 邬万新[2] 赵凤庆[1] 邹洪兴[3] 俞方荣[4] 周俊[1] 许浏[1] 徐鹿平[1] 孙建良[1] 

机构地区：[1]嘉兴学院附属第一医院肝胆外科,嘉兴市314000 [2]嘉兴学院附属第一医院病理科,嘉兴市314000 [3]嘉兴学院附属第一医院检验科,嘉兴市314000 [4]嘉兴学院附属第一医院放射科,嘉兴市314000

出　　处：《中华普通外科杂志》2008年第10期760-763,共4页Chinese Journal of General Surgery

基　　金：浙江省卫生厅基金项目（Y200711866）

摘　　要：目的研究隐性胰胆反流的发生率及其对胆囊上皮不典型增生和癌变的影响。方法对2006年7月至2008年2月期间择期行胆道手术或行ERCP检查的956例患者常规作胆汁淀粉酶测定，对手术切除胆囊标本行病理检查，观察不典型增生和癌变的发生率。结果754例患者中发现隐性胰胆反流75例，发生率为9．9％。反流组和对照组胆汁淀粉酶分别为（7701±20378）IU／L和（16±51）IU／L，差异有统计学意义（P〈0．01）：反流组中胆囊癌及不典型增生发生率分别为3．4％（2／58）和31．0％（18／58），均高于对照组（P〈0．05）。反流组中伴有癌变和不典型增生病例的胆汁淀粉酶值高于不伴有癌变和不典型增生的病例（9194±10399 IU／L vs．2388±2745 IU／L，P〈0．01）。结论在胆胰管汇合正常者中隐性胰胆反流是客观存在的，它促进了胆囊不典型增生和癌变的发生。Objective To investigate the incidence of occult pancreatobiliary reflux and to evaluate its relation to gallbladder epithelial dysplasia and cancer. Methods From July 2006 to Feb 2008,956 cases underwent selective biliary procedure or preoperative endoscopic retrograde cholangiopancreatography （ERCP）, bile was collected and amylase was measured. All removed gallbladders were pathologically examined for dysplasia and cancer. Results Occult pancreatobiliary reflux was found in 75 of 754 patients in this study, with an incidence of 9. 9%. The biliary amylase values in the patients with occult pancreatobiliary reflux and in controls were 7701 ± 20 378 IU/L and 16 ±51 IU/L, respectively （P 〈 0. 01 ）. Gallbladder dysplasia and cancer were found in 31.0% and 3.4% of the patients with occult pancreatobiliary reflux, respectively, and both were higher than those in the patients without pancreatobiliary reflux （ P 〈 0. 05）. In the patients with occult pancreatobiliary reflux, the biliary amylase level with gallbladder dysplasia or cancer was 2388 ± 2745 IU/L and was higher than those without gallbladder dysplasia or cancer （P 〈0. 01 ）. Conclusions With an incidence of 9.9% in patients of normal pancreatobiliary junction, the occult pancreatobiliary reflux may contribute to the pathogenesis of gallbladder epithelial dysplasia and cancer.

关 键 词：胰液 胆囊肿瘤 隐性胰胆反流 临床分析 

分 类 号：R686[医药卫生—骨科学]