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Korean J Pancreas Biliary Tract > Volume 3(2): > Article
췌담관 합류이상 유무에 따른 담관 낭종 환자의 임상적 비교 연구
김명환, 명승재, 김홍자, 심기남, 임병철, 유교상, 박은택, 서동완, 이성구, 민영일
울산대학교 의과대학 서울중앙병원 내과
Choledochal Cyst Associated with Anomalous Union of Pancreaticobiliary Duct (AUPBD) Has a More Grave Clinical Course Than Choledochal Cyst Alone
Myung Hwan Kim, Seung Jae Myung, Hong Ja Kim, Ki Nam Shim, Byeong Cheol Lim, Kyo Sang Yoo, Eun Taek Park, Dong Wan Seo, Sung Koo Lee, Young Il Min
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding author:  Myung Hwan Kim,
ABSTRACT
Background and Study Aims: Choledochal cyst is a congenital dilatation of the bile duct and frequently associated with anomalous union of pancreaticobiliary duct (AUPBD). AUPBD has been regarded to be the etiologic factor of choledochal cyst. However, the clinical significance of AUPBD in patients with choledochal cyst has not been clearly defined. The aims of our study were to compare the clinical features of patients with choledochal cyst according to the presence or absence of AUPBD, and to clarify the significance of AUPBD in choledochal cyst patients. Patients and
Methods:
From August 1990 to December 1996, 52 cases were diagnosed as having choledochal cyst out of 5,037 ERCP referrals. In 44 of 52 cases, the pancreaticobiliary junction was clearly visualized on cholangiopancreatography. We divided these cases into those associated with AUPBD (n=28, AUPBD-­present group) and those without (n=16, AUPBD-­absent group). Clinical features were compared between two groups. Furthermore, in AUPBD-present group, clinical data were also analyzed according to Kimura’s classification of AUPBD.
Results:
AUPBD was associated with choledochal cyst in 28 (64%) cases. According to Todani’s classification of choledochal cyst, AUPBD was found only in type I and IV cases. The incidence of gallstone disease in AUPBD-present group did not differ from that in AUPBD-absent group, while acute inflammation occurred more frequently in AUPBD-present (26/28, 93%) than in AUPBD-absent group (5/16, 31%)(p<0.01). Carcinoma developed only in AUPBD-present group (9/28, 32%), more often than in AUPBD-absent group (0/16, 0%)(p<0.05). Pancreatic disorders (i.e. pancreatic stone, pancreatitis, or pancreatic cancer) occurred in 12 of 28 cases in AUPBD-present group (43%), while only in 1 of 16 cases in AUPBD-absent group (6%)(p<0.05). Conclusion: AUPBD associated with choledochal cyst may have implication not only as a possible etiologic factor but also as an important factor that may affect the clinical course, surgical planning, and prognosis. In cases with choledochal cyst, we should make an effort to evaluate the presence of AUPBD.
Keywords: Anomalous union of pancreaticobiliary duct, Choledochal cyst, Prognosis
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