肝内胆管结石合并胆管癌相关因素探讨

The investigation of correlation factors of the calculus of intrahepatic duct with cholangiocarcinoma

目的探讨肝内胆管结石合并胆管癌相关临床因素及其演变过程。方法对420例肝内胆管结石接受手术的患者进行调查,内容包括年龄、合并肝病、胆道感染病程等。对80例疑有胆管癌者,术中于胆镜下钳取结石部位胆管炎症粘膜组织或切除肝脏标本,进行DNA含量及Agnor颗粒计数分析。结果年龄>50岁,合并丙肝或乙肝、肝硬化、胆道感染史>10年的47例患者发现胆管癌7例(14.8%)。DNA含量及Agnor颗粒计数:单纯增生与轻、中、重度非典型增生及高、中、低分化胆管癌均数逐渐升高。单纯增生组与轻度非典型增生组差异无显著性(P>0.05)。其余各两组差异均有统计学意义(P<0.05)。结论胆管结石合并胆管癌发生的可能机制是反复炎症刺激-胆管上皮增生、化生-癌形成的演变过程。

Objective To investigate the correlation clinical factors of the calculus of intrahepatic duct with cholangiocarcinoma.Methods Investigation was taken in 420 operated cases with intrahepatic bile duct stone,including age,combined liver diseases and the course of biliary infection.In 80 cases suspected cholangiocarcinoma,the biliary inflammation mucous membranes tissue of the stone position were obtained through a choledochoscope,the DNA content and the Agnor particle counting were analyzed in the above tissue.Results 7 of 47 patients combined cholangiocarcinoma whose age above 50,combined liver cirrhosis with C or B hepatitis and the history of infection of biliary tract was more than 10 years(14.8%).The means of DNA content and the Agnor particle counting gradually stepped up in the simple hyperplasy,low,middle and high degree atypism hyperplasy and the well,moderately,poorly differentiated cholangiocarcinoma tissue.There was no significantly difference between the simple hyperplasy and the low degree atypism hyperplasy group(P>0.05).And the DNA content and the Agnor particle counting differences between the other two groups were significant(P<0.05).Conclusion The development in the cholangiocarcinoma patients with intrahepatic bile duct stone may be thus process: repeatedly inflammation stimulated,bile duct epithelial proliferation and metaplasia and then cancerogenesis.