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目的观察十二指肠乳头开口位置与胰胆管合流异常(PBM)的关系。方法对64例伴有PBM的先天性胆总管囊肿(CBD)患儿、10例伴有PBM和30例无PBM的成人胰胆疾病患者的胆道造影进行分析,乳头开口于十二指肠第2段中1/3定为正常开口组,开口于第2段下1/3、第2、3段交界处和第3段的定为易位开口组;测乳头距十二指肠第2、3段交界处距离,实测长度除以椎体高度取得校正值。结果CBD患儿十二指肠乳头开口于第2段中1/3、下1/3、第2段与第3段交界处和第3段的分别占42%、22%、27%和9%。易位开口组和正常开口组的共通管长度校正值分别为0.89±0.42和0.66±0.31,P=0.03,囊肿长度校正值分别为3.0±1.1和2.2±0.5,P=0.001。共通管长度与乳头距十二指肠第2、3段交界处距离的相关系数为0.297,P=0.038。成人10例PBM患者中8例(80%)存在乳头易位开口,30例无PBM患者中12例42%存在乳头易位开口,两组间差异有显著性(P=0.03)。结论在伴有PBM的CBD患儿和胰胆疾病成人患者中,十二指肠乳头向远端开口易位发生率显著高于无PBM的病人,乳头开口越远,共通管越长。
Objective To observe the relationship between the open position of duodenal papilla and abnormal pancreaticobiliary duct (PBM). Methods Totally 64 patients with congenital choledochal cyst (CBD) accompanied by PBM, 10 patients with PBM and 30 patients without PBM were analyzed with cholangiography. The nipple was opened in the second part of duodenum Section 1/3 as a normal open group, opening in the second paragraph of the next 1/3, at the junction of paragraph 3 and paragraph 3 for the translocation opening group; measuring the second from the duodenum, 3 junction distance, the measured length divided by the vertebral height obtained correction. Results The incidence of duodenal papilla in CBD children was 1/3, 1/3, the junction of the second paragraph and the third paragraph and the third paragraph accounted for 42%, 22%, 27% and 9 %. The corrected values of common tube length for the translocation opening group and the normal opening group were 0.89 ± 0.42 and 0.66 ± 0.31, P = 0.03, respectively, and the cyst length correction values were 3.0 ± 1.1 and 2.2 ± 0.5, respectively, P = 0.001. The correlation coefficient between the common tube length and the distance of the nipple from the junction of the second and third duodenum was 0.297, P = 0.038. There were 8 cases (80%) of the 10 PBM adults with nipple translocation opening in 12 adults, and 42% of the 30 cases without PBM had nipple translocation opening. There was a significant difference between the two groups (P = 0.03). Conclusions The incidence of distal duodenal osseous open translocation was significantly higher in patients with CBD with PBM and in adult patients with pancreaticobiliary disease than in patients without PBM. The longer the nipple was, the longer the common duct was.