正常胰胆管汇合胰液胆管逆流对胆囊的影响  

Impact of pancreatobiliary reflux in normal pancreatobiliary junction on gallbladder

作　　者：祝喜萍[1] 任旭[1] 姜红[2] 李晓英[1] 张玲玲[1] 唐秀芬[1] 朱春兰[1] 

机构地区：[1]黑龙江省医院消化病院,哈尔滨150001 [2]黑龙江省医院消化病院病理科,哈尔滨150001

出　　处：《中华消化内镜杂志》2012年第12期669-672,共4页Chinese Journal of Digestive Endoscopy

基　　金：基金项目：黑龙江省科技厅自然科学基金项目（ZD200908）

摘　　要：目的探讨正常胰胆管汇合胰液胆管逆流（PBR）对胆囊的影响。方法54例行胆囊疾病需行胆囊切除患者，手术前腹部超声检测胆囊壁和内膜厚度并行胆囊壁血流检测，45例伴胆总管结石ERCP治疗时和9例手术中取胆汁测胆汁淀粉酶水平，根据胆汁淀粉酶水平分成PBR组（胆汁淀粉酶升高）和对照组（胆汁淀粉酶正常），切除胆囊标本行病理学及免疫组化（COX2、Ki-67、p53）检测，比较分析两组各项检测结果。结果PBR组24例，包括胆囊结石20例和胆囊息肉4例，23例为潜在性胰液胆管逆流（OPBR），1例为胰胆管高位汇合（HCPBD），后者与胰胆管汇合异常（PBM）有相似的病理改变；对照组30例，包括胆囊结石28例和胆囊息肉2例。胆囊壁和内膜厚度，胆囊壁血流，胆囊炎症、增生、化生，以及p53表达情况两组间比较差异均无统计学意义（P〉0．05），细胞异型、COX2和Ki-67表达水平两组间比较差异有统计学意义（P〈0．05）。结论OPBR患者胆囊黏膜增生和化生变化与胆囊结石所引起的病理改变无明显区别，但显示细胞异型和增殖活跃，OPBR可能为发生为胆囊癌的因素。Objective To explore the impact of pancreatobiliary reflux （PBR） in normal pancreato- biliary junction on gallbladder. Methods A total of 54 patients receiving cholecystectomy for gallbladder diseases underwent uhrasonography to evaluate the thickness of gallbladder wall, inner layer and gallbladder wall blood flow before operation. The bile juice was sampled during ERCP in 45 patients with common bile duct stone and during cholecystectomy in 9 patients to detect amylase level. All patients with normal panere- atobiliary junction enrolled in the study were assigned into PBR group （ n = 24 ） and controlled group （ n = 30） according to their bile amylase level. Resected gallbladder specimens were examined histopathologically and then tested for expression of COX2, Ki-67 and p53 immunohistochemically. Results PBR group in- eluded 20 cases of cholelithiasis and 4 gallbladder polyp, among which 23 were occult PBR （OPBR） and 1 high confluence of pancreatobiliary ducts （ HCPBD）, which was similar to pancreatobiliary maljunction （PBM） pathologically. The control group recruited 28 cases of cholelithiasis and 2 gallbladder polyp. There were no differences in frequency of inflammation, hyperplasia, metaplasia or expression of p53 between the two groups （ p 〉 0.05 ） , while higher presence of dysplasia and higher expression of COX2 and Ki-67 were seen in PBR group （ p 〈 0.05）. Conclusion In patients with OPBR, although hyperplasia and metaplasia in gallbladder epithelium were similar to those induced by cholelithiasis, dysplasia and active proliferation might relate to progress to malignancy.

关 键 词：胆囊 潜在性胰液胆管逆流 胰胆管高位汇合 胆汁淀粉酶 

分 类 号：R657.4[医药卫生—外科学]