【作者】 王璐；

【导师】 俞亚红；

【作者基本信息】 华中科技大学 ， 外科学（胆胰外科）， 2020， 硕士

【摘要】 目的:目前关于胰胆管合流异常(pancreaticobiliary maljunction,PBM)与胆道恶性肿瘤的相关性已经有大量文献报告,而隐匿性胰胆管反流(Occult pancreaticobiliary reflux,OPR)与胆道疾病的相关性研究报道仍然较少,本研究的目的是探讨OPR与胆道系统疾病的相关性。方法:选取2019年03月-2019年09月在华中科技大学附属同济医学院附属同济医院胆胰外科行磁共振胰胆管成像(Magnetic resonance cholangiopancreatography,MRCP)证实为原发性胆道系统疾病且胰胆管合流正常(normal pancreaticobiliary junction,NPJ)的94例患者,通过手术、内镜下逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)、经皮经肝胆道穿刺引流术(percutaneous transhepatic biliary drainage,PTCD)搜集入组患者胆汁并测定淀粉酶。本论文将探索:1.不同胆道疾病OPR发生率以及胆汁淀粉酶水平的差异性:根据入组患者胆道疾病类型进行分组,比较不同胆道疾病之间OPR发生率及胆汁淀粉酶水平的差异性;2.高胆汁淀粉酶(High biliary amylase levels,HBAL)与胆道良、恶性疾病的相关性:将入组患者按胆道疾病的良恶性分为三组:胆囊癌组、胆管癌组、良性胆道疾病组,分别将胆汁淀粉酶浓度高于1000IU/L、2000IU/L、7500IU/L定义为HBAL,比较三组间HBAL发生率的差异性;3.OPR的危险因素:根据胆汁淀粉酶水平是否高于血清淀粉酶正常水平范围的最高值,将入组患者分为OPR组和未发生OPR组,利用Logistic回归分析分别探索OPR的危险因素。结果:1.根据胆汁淀粉酶水平判定胆道疾病的OPR发生率为37.2%(35/94),此外,胆囊癌患者的OPR发生率最高(62.5%),胆总管结石患者OPR发生率次之(55.9%);不同胆道疾病患者的胆汁淀粉酶水平存在统计学差异(P=0.009)。胆囊癌患者中胆汁淀粉酶平均水平高于胆道其他良性疾病,但无统计学差异性,胆管癌患者中胆汁淀粉酶平均水平与其他良性胆道疾病无显著的统计学差异。2.当HBAL定义为胆汁淀粉酶水平超过1000IU/L时,胆道恶性肿瘤与胆道其他良性疾病的HBAL发生率无明显差异(P>0.05),当HBAL定义为胆汁淀粉酶水平超过2000IU/L、7500IU/L时,胆囊癌患者的HBAL发生率分别为50%(4/8)、37.5%(3/8),明显高于胆道其他良性疾病(P<0.05),而胆管癌患者HBAL发生率与胆道其他良性疾病无明显差异性(P>0.05)。3.单因素Logistic回归分析发现胆总管结石、乳头旁憩室是OPR的危险因素,多因素Logistic回归分析发现胆总管结石是OPR的独立危险因素。结论:OPR可以发生于胆道良、恶性疾病中,可能是某些胆道良性疾病的致病因素,是胆囊癌的高危因素。胆总管结石是OPR发生的独立危险因素。更多还原

【Abstract】 Objective: Recently,plenty of literature reported that pancreaticobiliary maljunction(PBM)was associated with biliary malignancies.However,the study of the correlation between occult pancreaticobiliary reflux(OPR)and biliary diseases was rare.The aim of our study was to explore the correlation between OPR and biliary diseases.Methods: 94 patients with normal pancreaticobiliary junction(NPJ)concomitant with primary biliary diseases that were confirmed by magnetic resonance cholangiopancreatography(MRCP)from March 2019 to September 2019,at the Tongji Hospital,Tongji Medical College,Huazhong Scientific and Technological University were selected.We collected patients’ bile through operation,endoscopic retrograde cholangiopancreatography(ERCP)or percutaneous transhepatic biliary drainage(PTCD)and then measured bile amylase.The study will explore: 1.The incidence rate of OPR and the difference of bile amylase levels among different biliary diseases: the enrolled patients were divided into different groups according to the types of biliary diseases to compare the incidence rate of OPR and the difference of bile amylase levels among different biliary diseases;2.The correlation between high biliary amylase levels(HBAL)and benign and malignant biliary diseases: according to the benign and malignant biliary diseases,the enrolled patients were divided into three groups: gallbladder cancer group,cholangiocarcinoma group and benign biliary diseases group.HBAL was defined as bile amylase concentration higher than 1000 IU/L,2000 IU/L and 7500 IU/L respectively,and the differences in the incidence rate of HBAL among three groups were compared.3.The risk factors of OPR: the enrolled patients were divided into OPR group and non-OPR group according to whether the level of bile amylase was higher than the maximum value of the normal range of serum amylase level,and the risk factors of OPR were explored respectively by Logistic regression analysis.Results: 1.The incidence rate of OPR in biliary diseases was 37.2%(35/94)according to the level of bile amylase.Furthermore,the incidence rate of OPR in patients with gallbladder cancer was the highest(62.5%),followed by that of choledocholithiasis(55.9%).There was a statistical difference in the level of bile amylase among patients with different biliary diseases.The average level of bile amylase was higher in patients with gallbladder cancer than other benign biliary diseases but there was no statistical difference,and the average level of bile amylase in patients with cholangiocarcinoma was not significantly different from other benign biliary diseases.2.If HBAL was defined as the level of bile amylase exceeding 1000 IU/L,there was no significant difference in the incidence rate of HBAL between biliary malignancies and other benign biliary diseases(P >0.05).However,if HBAL was defined as the level bile amylase exceeding 2000 IU/L,7500 IU/L respectively,the incidence rate of HBAL in patients with gallbladder cancer was 50%(4/8)and 37.5%(3/8),which were significantly higher than other benign biliary diseases(P <0.05).There were no significant differences in the incidence rate of HBAL between cholangiocarcinoma and benign biliary diseases(P >0.05).3.Single-factor Logistic regression analysis found that common bile duct stone and parapapillary diverticulum were risk factors of OPR.Multi-factor Logistic regression analysis revealed that common bile duct stone was an independent risk factor of OPR.Conclusion: OPR can occur in benign and malignant biliary diseases,and may be a pathogenic factor for some benign biliary diseases,and a high-risk factor for gallbladder cancer.Common bile duct stone is an independent risk factor for OPR.更多还原