关键词：胰、胆管先天异常；经内镜逆行胰胆管造影
摘要 为探讨异常胰胆管连接(APBDU)在胰胆系病变病因学中的作用及其发病机制，分析比较了79例APBDU和59例正常胰胆管连接患者的临床和经内镜逆行胰胆管造影结果；并用26只犬分三组建立动物模型，于术后第5～120天检测血清淀粉酶、磷脂酶A2 活性和甘胆酸含量，第90～270天作胰胆管造影和病理学检查。结果：胆管炎、胆管囊肿、胆系癌和慢性胰腺炎在APBDU组的发生率显著增高。实验研究也在多数犬复制出上述病变。结果提示APBDU对多种胰胆系病变有明确的致病作用，其致病机制是胆汁与胰液混流后，激活胰酶，从而引起胰胆管上皮损害。建议对于反复并发胰胆系病变的APBDU患者，在治疗胰胆系疾病的同时宜考虑实施胰胆管重建手术。
ANOMALOUS PANCREATICOBILIARY DUCTAL UNION AND DISORDERS：CLINICAL AND EXPERIMENTAL STUDY Lü Weifu ,Shen Tianming, Liu Ruifang. Department of Radiology,254th Hospital of PLA. Tianjin,300142
Abstract The objective of this study was to elucidate the connection of pancreaticobiliary disorders with anomalous ductal union. Clinical records and ERCP features of 79 patients with anomalous pancreaticobiliary ductal union (APBDU, group A) were analysed and compared with that of 59 cases with normal ductal union (group N).An experimental model of APBDU was established by anastomosis in 26 dogs. Post-operatively phospholipase A2 and amylase were determined on day 5～120； X-ray images and pathology of models checked on day 90～270. As a result, the incidence of clinical cholangitis, pancreatitis, choledocholithiasis, choledochocyst and biliary cancer was statistically higher in group A than group N. Most pathologic changes above mentioned were discovered in canine models. It is considered that abnormal union of bile and pancreatic ducts plays an essential role in inducing pancreaticobiliary disorders. Reconstruction between the ducts seems mandatory in treating patients with APBDU and repeated attacks.
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