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目的 研讨胆胰管合流异常 (APBDJ)在国人胆囊癌中的发生率及其相关因素 ,并对APBDJ的经内镜逆行胰胆管造影术 (ERCP)诊断标准作初步探讨。方法 2 0 0 0年 4月至 2 0 0 1年 9月期间 ,1876例患者接受ERCP诊疗 ,其中 10 82例胆管及胰管均显影 ,在这组患者中确定胆囊癌及APB DJ病例。APBDJ的诊断标准是胆、胰管共同通道的长度超过 15mm或壶腹部括约肌收缩段位于胆胰汇合部远侧。根据胆、胰管汇合的形态将其分成 2种类型 :P B型为胰管汇入胆管 ,B P型为胆管汇入胰管。结果 本组共发现胆囊癌 5 4例 ,其中 7例并发APBDJ(男 3例 ,女 4例 ;P B型 6例 ,B P型 1例 ) ,共同通道的平均长度 2 1 0mm(范围 12～ 4 5mm) ,1例尚合并胆管囊肿 ;另有 3例存在APBDJ(1例有胆管囊状扩张 ,2例胆胰管正常 )。APBDJ总发生率为 0 9% (10 / 10 82 ) ,均不合并胆囊结石 ,其在胆囊癌患者中的发生率高 (P <0 0 0 1) ,发病年龄较小 (P =0 0 5 6 )。结论 (1)国人胆囊癌的发生与先天性胆胰管合流异常有非常密切的关联 ,尤其易发于P B型 ;(2 )APBDJ的ERCP诊断标准可包括胆胰管共同通道长度超过 15mm或壶腹括约肌收缩段位于胆胰汇合部远侧。
Objective To investigate the incidence of APBDJ in Chinese gallbladder cancer and its related factors and to investigate the diagnostic criteria of endoscopic retrograde cholangiopancreatography (ERCP) by APBDJ. METHODS: From April 2000 to September 2001, 1876 patients underwent ERCP, of which 10 82 biliary and pancreatic duct were developed. Gallbladder cancer and APB DJ were identified in this group of patients. The diagnostic criteria of APBDJ is gall bladder. The length of the common duct of the pancreatic duct exceeds 15 mm or the contracting segment of the ampulla sphincter is located distal to the junction of the gallbladder and pancreas. According to the gallbladder and pancreatic duct confluence, it is divided into two types: type P B for the bile duct into the bile duct, type B P into the bile duct into the pancreatic duct. Results A total of 54 patients with gallbladder carcinoma were found in this study. Seven of them were complicated with APBDJ (3 males and 4 females; 6 PB males and 1 BP maze). The average length of common pathways was 210 mm (range 12-4 mm ), 1 case was complicated with cholangiocarcinoma, and 3 cases had APBDJ (1 case had cystic dilatation and 2 cases had normal biliary and pancreatic duct). The overall incidence of APBDJ was 0 9% (10/1082), with no gallstone involvement. The incidence of APBDJ was high in patients with gallbladder cancer (P 0 01) and was younger (P 0 05) 6). Conclusions (1) The occurrence of Gallbladder cancer in China is closely related to congenital anomalous cholangiopancreatography, especially in PB type. (2) The diagnostic criteria of ERCP in APBDJ may include the common channel length of biliary and pancreatic duct more than 15mm or pot Abdominal sphincter contraction is located in the distal biliary and pancreatic confluence.