CAJ | 학술논문

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.
목적 탐토정상이담관회합이액담관역류(PBR)대담낭적영향.방법 54례행담낭질병수행담낭절제환자,수술전복부초성검측담낭벽화내막후도병행담낭벽혈류검측,45례반담총관결석ERCP치료시화9례수술중취담즙측담즙정분매수평,근거담즙정분매수평분성PBR조(담즙정분매승고)화대조조(담즙정분매정상),절제담낭표본행병이학급면역조화(COX2、Ki-67、p53)검측,비교분석량조각항검측결과.결과 PBR조24례,포괄담낭결석20례화담낭식육4례,23례위잠재성이액담관역류(OPBR),1례위이담관고위회합(HCPBD),후자여이담관회합이상(PBM)유상사적병리개변；대조조30례,포괄담낭결석28례화담낭식육2례.담낭벽화내막후도,담낭벽혈류,담낭염증、증생、화생,이급p53표체정황량조간비교차이균무통계학의의(P＞0.05),세포이형、COX2화Ki-67표체수평량조간비교차이유통계학의의(P＜0.05).결론 OPBR환자담낭점막증생화화생변화여담낭결석소인기적병리개변무명현구별,단현시세포이형화증식활약,OPBR가능위발생위담낭암적인소.
Objective To explore the impact of pancreatobiliary reflux (PBR) in normal pancreatobiliary junction on gallbladder.Methods A total of 54 patients receiving cholecystectomy for gallbladder diseases underwent ultrasonography 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 pancreatobiliary 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 included 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.