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題名 | Bile Amylase Levels in Choledochal Cysts=先天性膽道囊腫內膽汁之澱粉酶之分析 |
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作者 | 林哲男; 江文山; 莊錦豪; Lin, Jer-nan; Kong, Man-shan; Chuang, Jiin-haur; |
期刊 | 中華民國外科醫學會雜誌 |
出版日期 | 19971100、19971200 |
卷期 | 30:6 民86.11-12 |
頁次 | 頁394-398 |
分類號 | 415.456 |
語文 | eng |
關鍵詞 | 先天性膽道囊腫; 膽汁; 澱粉酶; Choledochal cyst; Bile amylase; Abnormal pancreaticobiliary ductal junction; |
中文摘要 | 總膽管囊腫的成因及病理迄今尚未完全明瞭。胰液經不正常胰膽管合流逆流至總膽管一直被懷疑是先天性膽道囊腫重要成因之一。作者分析先天性膽道囊腫中澱粉酶數值與囊腫形狀及體積大小之關係來進一步探討其關連性。1980年至1990年共有38例膽道囊腫接受術後的研究,囊腫的大小、外形及膽汁澱粉酶的數據利用Chi Square方法分析。其中球狀及梭狀囊腫各佔19例。球狀囊腫中6例(31.6%)澱粉酶高於1000 IU/L,而13例(68.4%)則低於1000 IU/L。相反的,梭狀囊腫中17例(89.5%)澱粉酶高於1000 IU/L而只有2例(10.5%)低於1000 IU/L 。囊腫直徑小於8公分者共27例,其中21例(77.8%)澱粉酶高於1000 IU/L,而只有6例(22.2%)低於1000 IU/L。直徑大於8公分者共11例,其中只有2例(18.2%)澱粉酶高於1000 IU/L,而9例(81.8%)則低於1000 IU/L。二者之差異均有統計學意義(p< 0.001 )。所以囊腫中膽汁之澱粉酶在梭狀囊腫及囊腫直徑8公分以下者均有高於1000 IU/L之趨向。 因此我們推論,胰臟液之逆流至總膽管可能是最初梭狀膽道囊腫形成的原因。隨著時間的過去,遠端的總膽管變窄阻塞而使梭狀囊腫變大成為球狀膽道囊腫,而膽汁澱粉酶數值減少乃是由於總膽管遠端變窄及大量膽汁稀釋的關係。 |
英文摘要 | The etiology and pathogenesis of choledochal cysts remain unclear. The reflux of pancreatic juice into the bile duct through an abnormal pancreaticobiliary ductal junction has been incriminated as one of the major causes in forming this disorder. We investigated the levels of amylase in the bile of choledochal cysts in relation to the size and shape of the cysts to study pancreatic juice reflux in the etiology of this disorder. From 1980 through 1990, 38 patients with choledochal cysts underwent operations in this hospital and were included in this study retrospectively. The morphology of bile duct dilation and amylase levels aspirated from the bile of the cysts were evaluated using the Chi-Square test. There were 19 patients with cystic form cysts and 19 patients with fusiform cysts. Six (31.6%)patients with cystic form cysts had cyst amylase levels>1000 IU/L and 13 (68.4%) had levels<l000 IU/L. On the other hand, 17 (89.5%) patients with fusiform cysts had cyst amylase levels>1000 IU/L and 2 (10.5%) had levels <1000 IU/L. In patients with cysts<8 cm, 21 (77.8%) had cyst amylase levels >1000 IU/L and 6 (22.2%) had levels<1000 IU/L. In contrast, in those with cysts≧8 cm, 2 (18.2%) had cyst amylase levels>1000 IU/L and 9 (81.8%) had levels<l000 IU/L. Both of the differences are statistically significant (P< 0.001). The cyst amylase levels were usually higher than 1000 IU/L in the fusiform choledochal cysts and lower in the cystic form cysts, especially in cysts larger than 8 cm. In this study, we postulate that pancreatic juice reflux may initially cause fusiform dilatation of the common bile duct. As time goes by, the distal bile duct becomes stenotic, and the cyst size increases due to this mechanical factor rather than the reflux. The cyst amylase level decreases because of the stenosis and also the dilutional effect of bile. |
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