Relationship between Anomalous Pancreaticobiliary Ductal Union and Pathologic Inflammation of Bile Duct in Choledochal Cyst
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Choledochal cyst is a cystic dilatation of common bile duct. Although the etiology is presently uncertain, anomalous pancreaticobiliary ductal union (APBDU) is thought to be a major etiology of choledochal cyst. In this study, we analyzed the clinical and anatomical characteristics and pathologies of patients diagnosed with chol-edochal cyst in a single institute for 25 years.Methods: A total of 113 patients, diagnosed with choledochal cyst and who received an operation in Severance Children’s Hospital from January 1988 to May 2013, were included. Medical records were reviewed, including clinical and demographic data, surgical procedures. Abdominal ultrasonography, magnetic resonance cholangiopancreatog-raphy, and intraoperative cholangiography were used as diagnostic tools for evaluation and classification of chol-edochal cyst and the presence of anomalous pancreaticobiliary ductal union. Todani’s classification, and relationship between APBDU and surgical pathology.Results: Among 113 patients, 77 patients (68.1%) presented symptoms such as hepatitis, pancreatitis and/or cholecystitis. Eighty three patients (73.5%) had APBDU, and 94 patients (83.2%) showed inflammatory pathologic changes. APBDU, pathologic inflammation, and serological abnormalities such as hepatitis or pancreatitis showed a statistically significant correlation to one another.Conclusion: APBDU is thought to be one of the etiologic factors of choledochal cyst. It is related to the inflammatory changes in bile duct that can lead to the cystic dilatation.
Abstract
Purpose: Choledochal cyst is a cystic dilatation of common bile duct. Although the etiology is presently uncertain, anomalous pancreaticobiliary ductal union (APBDU) is thought to be a major etiology of choledochal cyst. In this study, we analyzed the clinical and anatomical characteristics and pathologies of patients diagnosed with chol-edochal cyst in a single institute for 25 years.Methods: A total of 113 patients, diagnosed with choledochal cyst and who received an operation in Severance Children’s Hospital from January 1988 to May 2013, were included. Medical records were reviewed, including clinical and demographic data, surgical procedures. Abdominal ultrasonography, magnetic resonance cholangiopancreatog-raphy, and intraoperative cholangiography were used as diagnostic tools for evaluation and classification of chol-edochal cyst and the presence of anomalous pancreaticobiliary ductal union. Todani’s classification, and relationship between APBDU and surgical pathology.Results: Among 113 patients, 77 patients (68.1%) presented symptoms such as hepatitis, pancreatitis and/or cholecystitis. Eighty three patients (73.5%) had APBDU, and 94 patients (83.2%) showed inflammatory pathologic changes. APBDU, pathologic inflammation, and serological abnormalities such as hepatitis or pancreatitis showed a statistically significant correlation to one another.Conclusion: APBDU is thought to be one of the etiologic factors of choledochal cyst. It is related to the inflammatory changes in bile duct that can lead to the cystic dilatation.
참고문헌 (30)
- Vater A, "Dissertatio de Scirrhis viscerum occasione sectionis viri tympanite defunte", Wittenburgae, 881, pp.22~
- Gigot JF, "Bile duct cysts: a changing spectrum of presentation", J Hepatobiliary Pancreat Sci, 3, pp.405~411 (1996)
- Lipsett PA, "Surgical treatment of choledochal cysts", J Hepatobiliary Pancreat Surg, 10, pp.352~359 (2003)
- Todani T, "Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst", Am J Surg, 134, pp.263~269 (1977)
- Yamaguchi M, "Congenital choledochal cyst. Analysis of 1,433 patients in the Japanese literature", Am J Surg, 140, pp.653~657 (1980)
- Khandelwal C, "Diagnosis and management of choledochal cysts", Indian J Surg, 74, pp.29~34 (2012)
- Burnweit CA, "The management of choledochal cysts in the newborn", Pediatr Surg Int, 11, pp.130~133 (1996)
- Casaccia G, "Cystic anomalies of biliary tree in the fetus: is it possible to make a more specific prenatal diagnosis?", J Pediatr Surg, 37, pp.1191~1194 (2002)
- Babbitt DP, "Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb", Ann Radiol, 12, pp.231~240 (1969)
- Tsuchiya R, "Malignant tumors in choledochal cysts", Ann Surg, 186, pp.22~28 (1977)
- Bismuth H, "Choledochal cystic malignancies", Ann Oncol, 10(4), pp.94~98 (1999)
- She WH, "Management of choledochal cyst: 30 years of experience and results in a single center", J Pediatr Surg, 44, pp.2307~2311 (2009)
- Liu CL, "Choledochal cysts in adults", Arch Surg, 137, pp.465~468 (2002)
- Kumar GCM, "Choledochal cyst", Med J Armed Forces India, 68, pp.296~298 (2012)
- Metcalfe MS, "Management dilemmas with choledochal cysts", Arch Surg, 138, pp.333~339 (2003)
- Lee HC, "Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance", J Ultrasound Med, 19, pp.177~182 (2000)
- Govil S, "Choledochal cysts: evaluation with MR cholangiography", Abdom Imaging, 23, pp.616~619 (1998)
- Chijiiwa K, "Surgical management and long-term follow-up of patients with choledochal cysts", Am J Surg, 165, pp.238~242 (1993)
- Pietrabissa A, "Unsuspected choledochal cyst during laparoscopic cholecystectomy", Surg Endosc, 9, pp.1127~1129 (1995)
- Singham J, "Choledochal cysts: part 2 of 3: diagnosis", Can J Surg, 52, pp.506~511 (2009)
- Yamashiro Y, "How great is the incidence of truly congenital common bile duct dilatation?", J Pediatr Surg, 28, pp.622~625 (1993)
- Kamisawa T, "Diagnostic criteria for pancreaticobiliary maljunction 2013", J Hepatobiliary Pancreat Sci, 21, pp.159~161 (2014)
- Han SJ, "Acquired choledochal cyst from anomalous pancreatobiliary duct union", J Pediatr Surg, 32, pp.1735~1738 (1997)
- Babbitt DP, "Choledochal cyst: a concept of etiology", Am J Roentgenol Radium Ther Nucl Med, 119, pp.57~62 (1973)
- O'Neill JA Jr, "Recent experience with choledochal cyst", Ann Surg, 205, pp.533~540 (1987)
- Sela-Herman S, "Choledochal cyst, a disease for all ages", Lancet, 347, pp.779~ (1996)
- Alonso-Lej F, "Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases", Int Abstr Surg, 108, pp.1~30 (1959)
- Büyükyavuz I, "A retrospective study of choledochal cyst: clinical presentation, diagnosis and treatment", Turk J Pediatr, 45, pp.321~325 (2003)
- Song HK, "Choledochal cyst associated the with anomalous union of pancreaticobiliary duct (AUPBD) has a more grave clinical course than choledochal cyst alone", Korean J Intern Med, 14, pp.1~8 (1999)
- Oguchi Y, "Histopathologic studies of congenital dilatation of the bile duct as related to an anomalous junction of the pancreaticobiliary ductal system: clinical and experimental studies", Surgery, 103, pp.168~173 (1988)