从整体性视角思考胆胰相关疾病的规范化诊治与研究
作者:
通讯作者:
作者单位:

上海交通大学医学院附属第六人民医院 肝胆胰外科,上海 200233

作者简介:

王坚,上海交通大学医学院附属第六人民医院主任医师,主要从事胆胰外科方面的研究。

基金项目:

国家自然科学基金资助项目 82273411国家自然科学基金资助项目(82273411)。


Standardized diagnosis, treatment, and research of biliopancreatic diseases from an integrated perspective
Author:
Affiliation:

Department of Hepatobiliary and Pancreatic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
  • |
  • 音频文件
  • |
  • 视频文件
    摘要:

    胆胰相关疾病具有共同的胚胎起源、毗邻的解剖关系、相互关联的生理功能及相似的疾病谱,其在发病机制、临床表现、诊断与治疗等方面亦存在密切联系。因此,从整体性视角认识胆胰相关疾病,对于明确病因、规范诊疗及优化治疗策略具有重要意义。当前临床实践中仍存在专科分割、整体性思维不足、过度依赖影像学而忽视病理依据,以及对Oddi括约肌功能及其保护认识不足等问题。针对不明原因的胆胰管扩张、胰腺段胆总管囊肿、胆管末端狭窄和Oddi括约肌功能障碍等诊疗难点,应加强胆胰相关疾病的整体化评估,重视多学科诊疗和系统化随访在诊疗决策中的作用,避免漏诊漏治、误诊误治及过度治疗。同时,应从整体性视角开展胆胰管汇合方式、胆胰肿瘤发病机制及精准诊疗、Oddi括约肌功能等方面的基础与临床研究,以进一步提高胆胰相关疾病诊疗的科学性、规范性和有效性。

    Abstract:

    Biliopancreatic diseases share common embryonic origins, close anatomical relationships, interconnected physiological functions, and similar disease spectra, with substantial similarities in their pathogenesis, clinical manifestations, diagnosis, and treatment. Therefore, an integrated perspective is important for identifying the underlying causes, standardizing clinical management, and optimizing therapeutic strategies for biliopancreatic diseases. However, current clinical practice is still characterized by excessive subspecialization and fragmentation, insufficient holistic thinking, overreliance on imaging findings with inadequate attention to pathological evidence, and insufficient recognition of the function and preservation of the sphincter of Oddi. For challenging conditions, including unexplained biliopancreatic duct dilatation, pancreatic-segment choledochal cysts, distal bile duct strictures, and sphincter of Oddi dysfunction, comprehensive assessment of the biliopancreatic system should be emphasized. Multidisciplinary team management and systematic follow-up should be incorporated into clinical decision-making to reduce missed diagnoses, inappropriate treatment, and overtreatment. Meanwhile, research from an integrated perspective should focus on the patterns of biliopancreatic duct confluence, the pathogenesis and precision management of biliopancreatic malignancies, and the basic and clinical characteristics of sphincter of Oddi function, thereby further improving the scientific, standardized, and effective management of biliopancreatic diseases.

    图1 V型和短Y型胆胰管汇合患者易患胆源性胰腺炎的机制图[10] A:U型汇合时由于不存在共同通道,理论上不会引起胆源性胰腺炎;B:长Y型汇合时若结石小,只阻塞共同通道,不梗阻胰管,胰液可以流入胆管,通过胆道系统的压力缓冲效应,胰管内压力不会急剧升高,短期内不一定会引起急性胰腺炎;C:V型汇合时胆管末端结石嵌顿会压迫胰管,如同胆囊结石压迫胆总管形成Mirizzi综合征,引起胰管开口水肿不畅,若结石自行排出,则只引起轻度水肿型胰腺炎,若结石无法排出,随着梗阻时间延长,胰管将从部分梗阻发展至完全梗阻,所以此型胆源性胰腺炎发病有一定过程,病程逐渐加重;D:短Y型汇合时胆管末端病变尤其是结石嵌顿可以同时阻塞胆胰管,极易引起急性胆管炎合并胆源性胰腺炎Fig.1 Mechanisms underlying the increased susceptibility to biliary pancreatitis in patients with V-type and short Y-type biliopancreatic duct confluence[10] A: In U-type confluence, there is no common channel, and therefore, biliary pancreatitis theoretically does not occur; B: In long Y-type confluence, small bile duct stones may obstruct only the common channel without blocking the pancreatic duct, pancreatic juice can drain into the bile duct, and pressure buffering within the biliary system prevents a sharp increase in pancreatic duct pressure, and therefore, acute pancreatitis may not develop immediately; C: In V-type confluence, an impacted distal bile duct stone may compress the pancreatic duct, similar to the compression of the common bile duct by a gallbladder stone in Mirizzi syndrome, resulting in edema and impaired drainage at the pancreatic duct orifice, if the stone passes spontaneously, only mild edematous pancreatitis may occur, and if the stone persists, partial pancreatic duct obstruction may progress to complete obstruction, resulting in a gradual aggravation of biliary pancreatitis; D: In short Y-type confluence, distal bile duct lesions, particularly impacted stones, may simultaneously obstruct the biliary and pancreatic ducts, readily resulting in acute cholangitis complicated by biliary pancreatitis
    图2 胆胰相关疾病整体化诊疗流程图 注:胆胰管梗阻的辅助特征包括突然截断或狭窄、胆管和胰管扩张共存、肝内胆管的伴随性扩张Fig.2 Flowchart for the integrated diagnosis and management of biliopancreatic diseases Note: Auxiliary features suggestive of biliopancreatic duct obstruction include abrupt ductal cutoff or stenosis, concomitant dilatation of the bile and pancreatic ducts, and associated dilatation of the intrahepatic bile ducts
    参考文献
    相似文献
    引证文献
引用本文

王伟,王坚.从整体性视角思考胆胰相关疾病的规范化诊治与研究[J].中国普通外科杂志,2026,35(8):1520-1528.
DOI:10.7659/j. issn.1005-6947.260449

复制
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2026-07-29
  • 最后修改日期:2026-08-17
  • 录用日期:
  • 在线发布日期: 2026-09-29
谨防不法人员冒充编辑

【温馨提醒】近日,《中国普通外科杂志》编辑部接到作者、编委反映,有不法人员冒充期刊编辑发送编委申请表,收集大家的个人信息。特提醒您,本刊唯一官方邮箱为:pw84327400@vip.126.com,编辑部电话为:0731-84327400,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!

关闭