论著

隐匿性胰胆反流的胆胰管汇合部解剖模拟分析:基于Fluent研究

  • 吕贝宁 ,
  • 侯念宗 ,
  • 项雨凯 ,
  • 达选博 ,
  • 杨玉龙 ,
  • 田伏洲
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  • 1.同济大学附属东方医院胆石病中心,上海 200120
    2.西部战区总医院全军普通外科中心,四川 成都 610083
杨玉龙,E-mail:yyl516@tongji.edu.cn

收稿日期: 2023-03-28

  网络出版日期: 2025-01-23

Anatomical simulation analysis of pancreaticobiliary junction in occult pancreaticobiliary reflux: based on Fluent study

  • Lü Beining ,
  • HOU Nianzong ,
  • XIANG Yukai ,
  • DA Xuanbo ,
  • YANG Yulong ,
  • TIAN Fuzhou
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  • 1. Center of Gallbladder Disease, Shanghai East Hospital, Tongji University, Shanghai 200120, China
    2. Department of General Surgery, Western Theater General Hospital, Sichuan Chengdu 610083, China

Received date: 2023-03-28

  Online published: 2025-01-23

摘要

目的:应用计算流体力学软件结合有限元法对胆胰管汇合部解剖结构进行2D数值模拟,分析胆胰壶腹隔膜、十二指肠乳头开口方向和形状对隐匿性胰胆反流(occult pancreaticobiliary reflux, OPBR)的影响。方法:利用网上资料获得胆胰管汇合部解剖结构数据。通过计算流体力学Fluent 2020R2软件2D重建。将胆胰管汇合部按以下条件绘制出不同模型:胆胰壶腹隔膜(有/无)、十二指肠乳头开口方向(偏向胆管/居中/偏向胰管),共6组模型,分析引起OPBR的危险因素。结果:在胆胰管汇合部解剖结构正常情况下,即壶腹隔膜存在,无论十二指肠乳头形状和开口方向如何改变,均未见胰胆反流。当壶腹隔膜缺失导致共同通道>5 mm,十二指肠乳头偏向胆管侧时,胰液少量反流进入胆管下端;当壶腹隔膜缺失导致共同通道>5 mm,十二指肠乳头居中时,反流进入胆管内的胰液流速、流量增大,反流程度维持在胆管下端;当壶腹隔膜缺失导致共同通道>5 mm,十二指肠乳头偏向胰管侧时,胰胆反流程度更严重,胆管全程可见胰液反流。在此反流模型基础上缩短胆胰管共同通道长度,扩大流出道开口后,胰胆反流现象消失。结论:基于Fluent研究发现,壶腹隔膜、十二指肠乳头等解剖结构与OPBR的发生密切相关,通过缩短胆胰管共同通道长度、扩大流出道开口可终止胰胆反流。

本文引用格式

吕贝宁 , 侯念宗 , 项雨凯 , 达选博 , 杨玉龙 , 田伏洲 . 隐匿性胰胆反流的胆胰管汇合部解剖模拟分析:基于Fluent研究[J]. 外科理论与实践, 2024 , 29(05) : 426 -433 . DOI: 10.16139/j.1007-9610.2024.05.10

Abstract

Objective Computational fluid dynamics software combined with finite element method was used to conduct 2D numerical simulation of pancreaticobiliary junction, and analyze the influence of biliopancreatic ampullary diaphragm, opening direction and shape of duodenal papilla on occult pancreaticobiliary reflux(OPBR). Methods The data of anatomical structure of pancreaticobiliary junction were obtained from online information. Pancreaticobiliary junction was reconstructed in 2D by computational fluid dynamics Fluent 2020R2 software. Different models were drawn for the pancreaticobiliary junction according to the following parameters: biliopancreatic ampullary diaphragm (with/without), opening direction of duodenal papilla(biased to the side of bile duct/central/biased to the side of pancreatic duct). A total of 6 models were used to analyze the risk factors for OPBR. Results When the anatomical structure of the biliopancreatic duct confluence was normal, that was, the ampullary diaphragm exists, no matter how the shape of the duodenal papilla and the opening direction changed, there was no pancreaticobiliary reflux. When the common channel was >5 mm due to the absence of the ampullary diaphragm and duodenal papilla was biased to the side of bile duct, a small amount of pancreatic juice refluxed into the lower end of the bile duct. When the common channel was >5 mm due to the absence of the ampullary diaphragm and duodenal papilla open position was in the middle of the biliopancreatic duct, the velocity and flow rate of pancreatic juice entering bile duct increased, and the degree of reflux was maintained at the lower end of the bile duct. When the common channel was >5 mm due to the absence of the ampullary diaphragm and the duodenal papilla was biased to the side of pancreatic duct, the degree of pancreaticobiliary reflux was more serious, and pancreatic juice reflux was observed throughout the entire bile duct. On the basis of this reflux model, the length of common channel of biliopancreatic duct was shortened, and the opening of outflow tract was enlarged, and the phenomenon of pancreaticobiliary reflux disappeared. Conclusions Based on the Fluent study, it is found that anatomical structures such as ampullary diaphragm and duodenal papilla were closely related to the occurrence of OPBR. Pancreaticobiliary reflux can be terminated by shortening the common channel length of pancreaticobiliary junction and expanding the opening of outflow tract.

参考文献

[1] 田伏洲. 胰胆管合流:人类又一个进化缺陷?[J]. 外科理论与实践, 2020, 25(6):453-455.
  TIAN F Z. Pancreaticobiliary junction: another evolutionary defect in human?[J]. J Surg Concepts Pract, 2020, 25(6):453-455.
[2] 刘永雄. 认真研习胆道生物力学重视保护胆胰结构和功能[J]. 中华肝胆外科杂志, 2012, 18(1):1-4.
  LIU Y X. Carefully investigate the biomechanics of bile duct and focus on the functional preservation of biliary and pancreas[J]. Chin J Hepatobiliary Surg, 2012, 18(1):1-4.
[3] LERCH M M, AGHDASSI A A, SENDLER M. Cell signaling of pancreatic duct pressure and its role in the onset of pancreatitis[J]. Gastroenterology, 2020, 159(3):827-831.
[4] 陆新良, 梁廷波. EST治疗中Oddi括约肌功能的保护及其意义[J]. 中国实用外科杂志, 2017, 37(8):871-873.
  LU X L, LIANG T B. Protection of Oddi sphincter function and its significance in endoscopic sphincterotomy[J]. Chin J Pract Surg, 2017, 37(8):871-873.
[5] 白忠学, 韩振奎, 高炜东. 胰管的应用解剖学及其临床意义[J]. 陕西医学杂志, 2004, 33(2):131-133.
  BAI Z X, HAN Z K, GAO W D. Applied anatomy of pancreatic duct for and its clinical significance[J]. Shaanxi Med J, 2004, 33(2):131-133.
[6] 张诚, 杨玉龙. 胰胆反流的临床分型及治疗[J]. 肝胆胰外科杂志, 2022, 34(5):257-260.
  ZHANG C, YANG Y L. Clinical classification and treatment of pancreaticobiliary reflux[J]. J Hepatopancreatobiliary Surg, 2022, 34(5):257-260.
[7] KAMISAWA T, ANDO H, SUYAMA M, et al. Japanese clinical practice guidelines for pancreaticobiliary maljunction[J]. J Gastroenterol, 2012, 47(7):731-759.
[8] 危小燕, 杨瑞芳, 吴云鹏. 胆汁流变特性与分类及本构方程[J]. 重庆大学学报(自然科学版), 1992(5):17-24.
  WEI X Y, YANG R F, WU Y P. The rheological properties and classification and constitutive equations of human bile[J]. J Chongqing Univ (Nat Sci Edition), 1992(5):17-24.
[9] 任志安, 郝点, 谢红杰. 几种湍流模型及其在FLUENT中的应用[J]. 化工装备技术, 2009, 30(2):38-40.
  REN Z A, HAO D, XIE H J. Several turbulent models and their application in FLUENT[J]. Chem Equipment Tech, 2009, 30(2):38-40.
[10] 吴志宇, 赵立新, 王瑛. 胆道流体力学的研究进展[J]. 肝胆胰外科杂志, 2011, 23(6):523-525.
  WU Z Y, ZHAO L X, WANG Y. Research progress in biliary fluid dynamics[J]. J Hepatopancreatobiliary Surg, 2011, 23(6):523-525.
[11] FUJIMOTO T, OHTSUKA T, NAKASHIMA Y, et al. Elevated bile amylase level without pancreaticobiliary maljunction is a risk factor for gallbladder carcinoma[J]. J Hepatobiliary Pancreat Sci, 2017, 24(2):103-108.
[12] BELTRáN M A, VRACKO J, CUMSILLE M A, et al. Occult pancreaticobiliary reflux in gallbladder cancer and benign gallbladder diseases[J]. J Surg Oncol, 2007, 96(1):26-31.
[13] KAMISAWA T, SUYAMA M, FUJITA N, et al. Pancreatobiliary reflux and the length of a common channel[J]. J Hepatobiliary Pancreat Sci, 2010, 17(6):865-870.
[14] ITOKAWA F, ITOI T, NAKAMURA K, et al. Assessment of occult pancreatobiliary reflux in patients with pancreaticobiliary disease by ERCP[J]. J Gastroenterol, 2004, 39(10):988-994.
[15] HORAGUCHI J, FUJITA N, NODA Y, et al. Amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement[J]. J Gastroenterol, 2008, 43(4):305-311.
[16] SUGIYAMA M, ATOMI Y. Endoscopic papillary balloon dilation causes transient pancreatobiliary and duodenobiliary reflux[J]. Gastrointest Endosc, 2004, 60(2):186-190.
[17] KATAOKA F, MIURA S, KUME K, et al. A case of occult pancreaticobiliary reflux due to endoscopically confirmed relaxation of the Oddi sphincter[J]. DEN Open, 2022, 3(1):e161.
[18] 杨玉龙. 对隐匿性胰胆反流的研究及探讨[J]. 外科理论与实践, 2019, 24(2):116-120.
  YANG Y L. Study on occult pancreaticobiliary reflux[J]. J Surg Concepts Pract, 2019, 24(2):116-120.
[19] 杨玉龙. 经皮经肝胆囊穿刺引流术后胆胰汇合部疾病诊治策略[J]. 中华医学杂志, 2019, 99(4):253-255.
  YANG Y L. Diagnosis and treatment strategy of biliary-pancreatic confluence disease after percutaneous transhepatic gallbladder puncture and drainage[J]. Natl Med J China, 2019, 99(4):253-255.
[20] 黎冬暄, 田伏洲, 李红, 等. 胆胰合流部解剖特点及其意义——23例新鲜标本解剖结果报告[J]. 四川医学, 1998,1:8-9.
  LI D X, TIAN F Z, LI H, et al. Anatomical characteristics and significance of the bile pancreatic confluence: a report on the anatomical results of 23 fresh specimens[J]. Sichuan Med J, 1998,1:8-9.
[21] 李旭, 王雨, 田伏洲, 等. T管造影合并胰管显影的临床意义[J]. 重庆医学, 1999, 28(4):253-254.
  LI X, WANG Y, TIAN F Z, et al. Clinical significance of T-tube angiography combined with pancreatic duct imaging[J]. Chongqing Med J, 1999, 28(4):253-254.
[22] 田伏洲, 黎冬暄, 陈玉琼, 等. 胰、胆管压力变化及胆胰返流的原因分析[J]. 中华实验外科杂志, 1997, 14(4):207-208.
  TIAN F Z, LI D X, CHEN Y Q, et al. Analysis of changes in bile duct pressure and causes of bile duct pancreatic reflux[J]. Chin J Exp Surg, 1997, 14(4):207-208.
[23] 许宁, 唐权伟, 张作英, 等. 肝胰壶腹隔膜解剖学研究及功能探讨[J]. 医学信息(下旬刊), 2011, 24(1):1-2.
  XU N, TANG Q W, ZHANG Z Y, et al. Anatomy of liver and pancreatic function ampulla of membrane[J]. Med Inf, 2011, 24(1):1-2.
[24] DIMAGNO E P, SHORTER R G, TAYLOR W F, et al. Relationships between pancreaticobiliary ductal anatomy and pancreatic ductal and parenchymal histology[J]. Cancer, 1982, 49(2):361-368.
[25] 林美举, 张诚, 杨玉龙, 等. 正常胰胆管合流病人胆汁淀粉酶升高的病因分析及内镜治疗[J]. 外科理论与实践, 2021, 26(1):54-57.
  LIN M J, ZHANG C, YANG Y L, et al. Etiological analysis of elevation of bile amylase level in patients with normal pancreaticobiliary junction and endoscopic treatment[J]. J Surg Concepts Pract, 2021, 26(1):54-57.
[26] 张诚, 杨玉龙. 胆胰管汇合部疾病与胆囊切除术后综合征关系的认识[J]. 外科理论与实践, 2020, 25(6):460-463.
  ZHANG C, YANG Y L. Long-term complications after endoscopic sphinctectomy: sphincter Oddi dysfunction and treatment[J]. J Surg Concepts Pract, 2020, 25(6):460-463.
[27] FUKUZAWA H, KAJIHARA K, TAJIKAWA T, et al. Mechanism of pancreatic juice reflux in pancreaticobiliary maljunction: a fluid dynamics model experiment[J]. J Hepatobiliary Pancreat Sci, 2020, 27(5):265-272.
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