Clinicopathologic Study of Biliary Tract Lesions Associated with Anomalous Arrangement of the Pancreaticobiliary Ducts

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We carried out pathological examinations of differences in biliary tract lesions according to the shape of the extrahepatic bile duct in surgical patients with anomalous arrangement of the pancreaticobiliary ducts (AAPD). In our study, while chronic cholecystitis was histologically observed in the resected specimens of all patients, the gallbladders in the non-dilated group showed more severe inflammation and more associated lesions, such as gallbladder cancer and dysplasia, than did those in the dilated group. In addition, in the dilated group, inflammation of the bile duct was slightly more advanced, accompanied by more complications including dysplasia, than in the non-dilated group. In other words, type b was frequent among the patients without ductal dilatation including 2 who had gallbladder cancer, suggesting that a non-dilated bile duct was a high risk factor of gallbladder cancer. The surgical procedure for AAPD was considered in view of the above analytical findings. Cholecystectomy is thought to be indicated for patients with AAPD even with an intact gallbladder, because in the absence of cholangiectasis, the gallbladder is the center of the lesion and has shown a high risk rate for carcinogenesis. In contrast, regardless of the presence or absence of cystic lesions, cholecystectomy and choledochectomy are recommended for patients showing cholangiectasis, in whom the bile duct is the center of changes, accompanied by a high incidence of carcinogenesis.

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  • 北里医学

    北里医学 27 (3), 191-195, 1997-06-30

    北里大学

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