胆道闭锁Kasai术后胆管病理改变的研究

发布时间：2018-03-11 00:05

本文选题：胆道闭锁　切入点：病理　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:研究胆道闭锁患儿Kasai术后肝内胆管结构病理改变,分析其与胆管炎之间的关系,并探讨Kasai术后肝门结构改变与肝内病理改变的差异,为临床分析胆管炎发生及治疗胆管炎以及对改进Kasai手术提供理论依据。方法:1、收集胆道闭锁患儿Kasai术后行肝移植手术切除的自体肝脏标本16例,作为移植;同时收集胆道闭锁患儿行Kasai手术中肝脏活检标本16例,作为Kasai组。采用HE和免疫组化等技术分别检测汇管区小叶间胆管直径、汇管区管腔数量;汇管区小叶间胆管增生分级;汇管区胆栓分级;炎症细胞浸润分级;小叶间胆管板畸形等,收集临床上胆管炎发生情况,进一步分析其与临床发生胆管炎的关系。2、收集Kasai术后因胆汁淤积性肝硬化行肝移植手术的胆道闭锁患儿13例,因术后黄疸持续不退,肝功能进行性恶化,胆汁引流情况较差,作为引流不良组,切取肝门及肝内组织。收集3例Kasai术后退黄情况好,肝功能恢复,逐渐出现肝门部囊肿,再发生黄疸而行肝移植手术,作为引流良好组,并于肝肠吻合口处留取肝组织,沿左右肝管分别间隔1 cm连续取材。结果:1、移植组与Kasai组自体肝脏标本病理比较:术后胆管直径增大,开放的胆管管腔数量减少,胆管及胆管上皮增生程度加重,胆栓及炎细胞浸润程度减轻,可见较多团块型胆管板畸形;移植组胆管管腔数量明显少于对照组,炎细胞浸润程度明显低于Kasai组,而胆管上皮增生程度明显重于对照组,P0.05,差异有显著性;移植组患儿肝内不同部位胆管病理结构改变:发现肝左叶胆管损伤最重;右叶胆管损伤最轻,但是炎细胞浸润较重;肝门处胆管直径最大,淤胆最重;移植组胆管直径总和300μm,Kasai手术日龄60天,其自体肝生存的时间相对较长,肝移植时间较晚,发生胆管炎频次减少,术后黄疸消退情况较好。2、引流不良组肝内病理改变以纤维化加重,胆管增生及血管增生为主,淤胆及炎细胞浸润较轻,汇管区可见小的胆汁湖。肝门纤维化程度严重,尤其可见较多孤立的假小叶,增生的胆管逐渐侵入肝小叶,肝细胞逐渐退化,肝门淤胆程度较肝内相对加重;引流良好组从肝肠吻合处逐渐向肝内解剖发现:肝左叶炎症及胆栓程度逐渐减轻,以大胆管为主,开放管腔相对较少,胆管直径较大,最大为750μm:肝右叶各部位损伤程度无明显区别,胆管增生明显,开放胆管管腔较多,胆管直径较小,最大为390μm。结论:胆道闭锁患儿Kasai术后汇管区胆管增生情况,开放胆管的直径等肝内胆管病理改变影响术后胆管炎的发生频次,早期行Kasai手术可以适当减轻胆管的损伤,延长Kasai术后自体肝生存时间;Kasai术后胆汁引流较好的病例均呈现左叶胆管直径较大,可能提示解剖肝门广度需要增加。
[Abstract]:Objective: to study the pathological changes of intrahepatic bile duct structure in children with biliary atresia after Kasai, and to analyze the relationship between them and cholangitis, and to explore the difference between hepatic hilus structure and intrahepatic pathological changes after Kasai. In order to analyze the occurrence and treatment of cholangitis and to provide theoretical basis for improving Kasai operation, 16 autologous liver specimens of children with biliary atresia underwent liver transplantation after Kasai operation were collected as transplantation. Liver biopsy specimens were collected from 16 cases of children with biliary atresia undergoing Kasai operation as Kasai group. The diameter of interlobular bile duct, the number of lumen of portal duct and the grade of intralobular bile duct hyperplasia were detected by HE and immunohistochemical techniques. Bile embolus grade, inflammatory cell infiltration grade, interlobular bile duct plate malformation and so on. The clinical occurrence of cholangitis was collected. The relationship between cholangitis and cholangitis was further analyzed. Thirteen children with biliary atresia underwent liver transplantation for cholestatic cirrhosis after Kasai were collected. As the group of poor drainage, the hilus of liver and the liver tissue were removed. 3 cases of Kasai had good yellow condition after operation, the liver function recovered, the hepatic hilar cyst appeared gradually, and then the jaundice occurred and the liver transplantation was performed, which was used as the good drainage group. The liver tissue was taken from the anastomotic site of liver and intestine, and the liver tissue was collected continuously along the left and right hepatic ducts. Results compared with Kasai group, the diameter of bile duct increased and the number of open bile duct lumen decreased. The degree of hyperplasia of bile duct and bile duct epithelium was aggravated, the degree of infiltration of bile embolus and inflammatory cells was reduced, the number of bile duct lumen in transplantation group was obviously less than that in control group, and the infiltration degree of inflammatory cells in transplantation group was obviously lower than that in Kasai group. The degree of hyperplasia of bile duct epithelium was significantly higher than that of control group (P 0.05). The pathological changes of bile duct in transplantation group were as follows: the bile duct injury of Zuo Ye was the most serious, the injury of right lobe bile duct was the least, but the infiltration of inflammatory cells was serious. The diameter of bile duct at the hilar of liver was the largest and the cholestasis was the most serious, and the total diameter of bile duct in the transplantation group was 300 渭 m Kasai, the survival time of autologous liver was relatively long, the time of liver transplantation was late, and the frequency of cholangitis was decreased. Postoperative jaundice subsided better. The pathological changes of liver in poor drainage group were aggravated by fibrosis, bile duct hyperplasia and vascular hyperplasia, cholestasis and inflammatory cell infiltration were light, small bile lake could be seen in the catchment area, the degree of hepatic hilar fibrosis was serious. In particular, more isolated pseudolobules were observed. The proliferative bile duct gradually invaded the hepatic lobules, the hepatocytes gradually degenerated, and the degree of cholestasis in the hepatic hilus was more serious than that in the liver. In the good drainage group, it was found that the degree of inflammation and bile embolism of the liver Zuo Ye was gradually reduced from the anastomosis of the liver to the intestine, with the bold tube as the main, the opening lumen was relatively small, and the diameter of the bile duct was larger. The maximum was 750 渭 m: the degree of injury in right lobe of liver had no obvious difference, the bile duct hyperplasia was obvious, the open bile duct lumen was more, the diameter of bile duct was smaller, the maximum was 390 渭 m. Conclusion: bile duct hyperplasia in bile duct area after Kasai in children with biliary atresia. The pathological changes of intrahepatic bile duct, such as the diameter of open bile duct, influence the frequency of postoperative cholangitis. Early Kasai operation can reduce the injury of bile duct. Prolonging the survival time of autologous liver after Kasai and good bile drainage after Kasai all showed that the diameter of Zuo Ye bile duct was larger, which might suggest that the breadth of anatomical hepatic hilus should be increased.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R726.5

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