摘要目的 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.

abstractsObjective 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.