The Relationship Between Abnormal Pancreaticobiliary Confluence And Gallbladder Disease

Objective:Pancreaticobiliarymaljunction(PBM)is a congenital disease with abnormal confluence of pancreatic duct and bile duct.Through this prospective study,we investigated the correlation between abnormal biliary confluence and gallbladder disease,elucidated the early diagnostic strategy of PBM without bile duct dilatation,and performed pathological examination of the gallbladder before cancer development.Methods:A prospective study was conducted on patients requiring surgical cholecystectomy in our hospital from June 2019 to July 2020,including patients with gallbladder disease,patients with PBM who had gallbladder wall thickening and no bile duct dilatation,and patients with non-biliary system diseases who underwent pancreaticoduodenal surgery.(1)Patients with gallbladder disease were diagnosed with abnormal pancreaticobiliary junction according to the length of common pancreaticobiliary channel,serum amylase level,amylase level in gallbladder bile and postoperative histopathological examination measured by imaging examination,which was PBM group;those without abnormal pancreaticobiliary junction were control group.(2)Patients with the maximum diameter of bile duct less than 10 mm were diagnosed as PBM without bile duct dilatation,patients with PBM with gallbladder wall thickening and no bile duct dilatation who underwent cholecystectomy were in group A,and patients with non-biliary system diseases who underwent pancreaticoduodenal surgery were in group B.Histopathological analysis of cholecystectomy specimens was performed in the two groups AB.Results:Of the 68 patients with PBM,22 were gallbladder stones,10 were gallbladder polyps,6 were gallbladder adenomyosis,and 30 were gallbladder cancer.In the control group,there were 103 cases of gallbladder stones,59 cases of gallbladder polyps,42 cases of gallbladder adenomyosis,and gallbladder.There were 22 cases of cancer.There was no significant difference in the incidence of gallbladder benign lesions(gallbladder stones,gallbladder adenomyosis,gallbladder polyps)between the two groups(P>0.05).The occurrence of gallbladder malignant lesions(gallbladder cancer)in the two groups There is a significant difference in the rate(χ2=54.406,P<0.05);the PBM pancreaticobiliary duct confluence classification has no significant effect on the pathological differentiation of gallbladder cancer(P>0.05).The degree of gallbladder bile amylase elevation in PBM patients with gallbladder cancer was significantly higher than that of PBM patients with benign gallbladder diseases.In patients with PBM,the content of gallbladder bile amylase is related to the occurrence of gallbladder cancer(χ2=5.83,P<0.05),and there is a significant difference with the incidence of poorly differentiated gallbladder cancer,the difference is statistically significant(χ2=4.852,P<0.05)。According to ultrasound findings,the thickening of the gallbladder wall was suspected of having PBM but no bile duct dilatation,8 cases were diagnosed by ERCP and/or magnetic resonance cholangiopancreatography(MRCP).The median age of these 8 patients was 10 years younger than that of patients with PBM with gallbladder cancer.All 8 patients underwent prophylactic cholecystectomy,and no cholangiocarcinoma has occurred since follow-up.The wall thickness and mucosal height of these 8 gallbladders were significantly greater than those in group B.Among them,7 cases of gallbladder wall hyperplasia(88%),5cases of basal hypertrophy(63%),7 cases of submucosal fibrosis(88%),There were 5cases(63%)of adenomyomatosis.The Ki-67 labeling index of these 8 cases was high,and K-ras mutation was detected in 4 cases.Conclusion:PBM is correlated with gallbladder cancer,while the pancreaticobiliary duct confuence classification has nothing to do with the pathological classification of gallbladder cancer;PBM with elevated gallbladder bile amylase is more likely to get gallbladder cancer,and is related to poorly differentiated gallbladder cancer.The existence of PBM does affect the proliferation of the gallbladder mucosa,and the possibility of gallbladder malignancy in PBM patients increases.In order to detect PBM without bile duct dilatation before the onset of gallbladder cancer,we should perform MRCP on individuals with increased gallbladder wall thickness on ultrasound.