| Objective: Congenital choledochal cyst (CCC) is a common biliary malformation in pediatric surgery. Recently, researches indicate that anomalous junction of pancreaticobiliary duct (AJPBD) is a congenital malformation of the pancreatic and biliary ductal systems, By analyzing pathological variation and cell proliferation, the regular pattern of pathology can be found, it can refer the theory base to operational therapy and prevent from cancer. In the meanwhile, illustrate the relation between AJPBD and congenital choledochal cyst by determining of blood serum and bile amylase and cholangiography.Methods: 26 CCC patients, in them 22 cases were children and the others were adults. B style ultrasonic examine be performed for liver and gall of every case before operation to find out the shape and type of cyst. The other examines included determining amount of blood serum and bile amylase and proceeding cholangiography be performed to understand if occurred AJPBD. In the meanwhile, the specimen be selected including of common hepatic duct, wall of cyst, constriction in the cyst extremity, gallbladder and neck of gallbladder separately, then firmed by 10%formaldehyde and covered by paraffin wax. The thickness of every specimen section, which include 6～8 slices, is 4～6 μm. The microstructures of the specimens can be observed by optic microscope after colored by haematine-eosin. Four of the patients specimens firmed by 4% glutaral then microstructures can be observed by electric microscope after proceeded. PCNA had been proceed in the 20 case of them and the index of PCNA had been counted. The results had been performed statistics analysis and the significant can be found.Results: 1. 20 of 26 patients with congenital choledochal cyst were diagnosed as having AJPBD by intraoperative cholangiography, The incidence of AJPBD was 91% except 4 cases failing in cholangiography. The average length of common channal was 13.97±6.95mm,coincidence the standard of diagnosis in AJPBD. 2.The variation of bile duct in pathology in respectively as follows. 26 case had been observed by optics microscope in the part of common hepatic duct, wall of cyst, constriction in the cyst extremity, gallbladder and neck of gallbladder .The result of all the case is that the normal structure of choledochowall is variant. The expand, edema, hyperemia, comprehensive inflammatory cell infiltration can be found in the wall of gallbladder. neutrophil,eosinophil can be found in the wall of cyst by electric microscope. The seriousness of pathological variation is increase with the patient age and the period ofdisease. 3.The increased production of cell in PCNA experiment group is more active than the contrast group in every part of bile duct of extra-liver. In the PCNA experiment group, the active increased production of cell in PCNA of group in posterior wall of cyst is the most serious. (F=85.663, P<0.01).The cell proliferation is companied with the age of patient and the period of disease by PCNA in experiment group(P<0.01). 4. The amount of bile amylase in AJPBD group(30125.43±3513.24U/L) is more than that in no AJPBD group(1689.33±801.55U/L)(P<0.01)and that in shuttle expand group(44603.33±9506.28U/L)is more than that in cyst expand group(20731.05±9987.82U/L)(P<0.05). The amount of blood serum is more in the preoperation( 175.34±173.28U/L)than that in the postoperation( 97.62±69.08U/L)(P<0.05)in all of 26 case and that in the AJPBD group(123.32±114.95U/L)is more than that in no AJPBD group( 59.53±5.05U/L)(P<0.05)。 Conclusion: According to the pathological variation and PCNA immunohistochemistry in the extra-liver bile duct including common hepatic duct, wall of cyst, constriction in the cyst extremity, gallbladder and neck of gallbladder. It is can be found that the AJPBD is the important factor for congenital choledochal cyst and proliferation in mucous membrane of extra-liver bile duct from the born, whose active is increased slowly and continually with the age of pati...
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