十二指肠水平段主乳头与胆胰疾病关系的单中心回顾性研究

A single‑center retrospective study of the relationship between horizontal duodenal papilla and biliary and pancreatic diseases

摘要:

目的 探讨十二指肠水平段主乳头（horizontal duodenal papilla， HDP）在可疑胆胰疾病人群中的发生率、胆胰疾病谱及胆胰管形态。方法 回顾性分析2021年1—12月在空军军医大学第一附属医院所有因可疑胆胰疾病行磁共振胆胰管成像（magnetic resonance cholangiopancreatography，MRCP）的患者，根据主乳头位置分为HDP组和常规组，对比两组合并胆胰疾病的情况，测量胆总管-胰管-十二指肠夹角、肝外胆管长度以及胆总管成角并比较。结果 共纳入符合纳入标准且不满足排除标准的MRCP病例1 009例，HDP的发生率为3.1%（31/1 009），未发现其他异位乳头情况。与常规组相比，HDP组先天性胆总管囊肿占比［9.7%（3/31）比0.8%（8/978），P=0.004］及胆胰管合流异常占比［6.5%（2/31）比0.9%（9/978），P=0.042］显著升高，胆囊癌的占比较高但差异无统计学意义［6.5%（2/31）比1.4%（14/978），P=0.084］。HDP患者肝外胆管中位长度更长（8.6 cm比7.2 cm，Z=-5.48，P<0.001），胆总管-十二指肠中位夹角（86.6°比38.3°，Z=-7.63，P<0.001）、胆总管-胰管中位夹角（18.0°比40.8°，Z=-5.54，P<0.001）和胰管-十二指肠中位夹角（102.0°比77.3°，Z=-5.68，P<0.001）明显有别于常规组。结论 HDP在可疑胆胰疾病人群中的发生并非罕见。HDP可能与先天性胆胰管发育异常性疾病相关，与胆囊癌的关系值得更大样本的探索。HDP人群的肝外胆管长度及角度有别于正常人群。

Abstract:

Objective To explore the incidence, spectrum of biliary and pancreatic diseases, and morphology of bile and pancreatic ducts in patients with horizontal duodenal papilla (HDP) who had suspected biliary and pancreatic diseases. Methods A retrospective analysis was conducted on data of consecutive patients who underwent magnetic resonance cholangiopancreatography (MRCP) at the First Affiliated Hospital of Air Force Medical University from January 2021 to December 2021. Patients were divided into HDP group and regular group based on their papilla position. The incidence of biliary and pancreatic diseases was compared. The angle between the common bile duct (CBD), pancreatic duct, and duodenum, and the length of the extrahepatic bile duct were measured and compared between the two groups. Results A total of 1 009 MRCP cases that met the inclusion criteria were analyzed. The incidence of HDP was 3.1% (31/1 009). No other ectopic papilla was found. Compared with the regular group, the HDP group had a significantly higher proportion of congenital choledochal cysts [9.7% (3/31) VS 0.8% (8/978), P=0.004] and anomalous biliary-pancreatic duct junction [6.5% (2/31) VS 0.9% (9/978), P=0.042], and a numerically higher incidence of gallbladder cancer without significant difference [6.5% (2/31) VS 1.4% (14/978), P=0.084]. Patients in the HDP group had longer median extrahepatic bile ducts (8.6 cm VS 7.2 cm, Z=-5.48, P<0.001), and the median angles between CBD-duodenum (86.6° VS 38.3°, Z=-7.63, P<0.001), CBD-pancreatic duct (18.0° VS 40.8°, Z=-5.54, P<0.001) and pancreatic duct-duodenum (102.0° VS 77.3°, Z=-5.68, P<0.001) were significantly different from those in the regular group. Conclusion HDP in patients with suspected biliary and pancreatic diseases is not rare. It may be associated with developmental abnormalities of biliary and pancreatic ducts, and the relationship with gallbladder cancer deserves further exploration with larger sample sizes. Differences in the length and angle of the extrahepatic bile duct are observed in patients with HDP compared to the normal population.