Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation

作     者：Kensuke Takuma Terumi Kamisawa Taku Tabata Seiichi Hara Sawako Kuruma Yoshihiko Inaba Masanao Kurata Goro Honda Koji Tsuruta Shin-ichiro Horiguchi Yoshinori Igarashi 

作者机构：Department of Internal MedicineTokyo Metropolitan Komagome HospitalTokyo 113-8677Japan Department of SurgeryTokyo Metropolitan Komagome HospitalTokyo 113-8677Japan Departments of PathologyTokyo Metropolitan Komagome HospitalTokyo 113-8677Japan Department of Gastroenterology and HepatologyOmori Medical CenterToho University School of MedicineTokyo 143-8541Japan 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2012年第18卷第26期

页      面：3409-3414页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Pancreaticobiliary maljunction Pancreato-biliary reflux Ultrasound Gallbladder cancer Endo-scopic ultrasonography 

摘      要：AIM:To clarify the strategy for early diagnosis of pancreaticobiliary maljunction(PBM) without biliary dilatation and to pathologically examine gallbladder before cancer ***:The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography(ERCP).Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having *** these,patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary *** process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively *** analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was ***:Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain(n = 16) or jaundice(n = 12).Radical surgery for gallbladder cancer was only possible in 11 patients(31%) and only 4 patients(11%) survived for 5 *** patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography(MRCP).The median age of these 8 patients was younger by a decade than PBM patients with gallbladder *** 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not *** thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls,and hyperplastic changes,hypertrophic muscular layer,subserosal fibrosis,and adenomyomatosis were detected in 7(88%),5(63%),7(88%) and 5(63%) patients,***-67 labeling index was high and K-ras mutation was detected in 3 of 6 ***:To detect PBM without biliar