肝门部胆管癌神经浸润及神经丛分布的临床病理学研究

Ciinicopathologic study on perineural invasion of hilar cholangiocarcinoma and distribution of nerve plexuses around hepatic portal

目的 探讨肝门部胆管癌神经浸润的方式和规律及肝门部神经丛分布的特点。方法 观察68例肝门部胆管癌患者的病理切片，总结归纳肿瘤神经浸润的方式和规律；分析5例尸检标本正常肝十二指肠韧带内的神经丛分布特点。结果62例患者发生肿瘤神经浸润，神经浸润与淋巴结浸润和患者血清CA19-9水平无关（u=0．878，P〉0．05）。高、中、低分化组肿瘤神经浸润发生率之间差异无统计学意义（Х^2=0．614，P〉0．05）。肿瘤浸润神经有5种方式，肝十二指肠韧带与一、二级肝管所在的Glisson鞘内分布的神经丛主要有3丛。结论肝门部胆管癌神经浸润发生率高，行根治性切除时应紧贴血管外膜仔细剥除其周围神经纤维组织。

Objective To explore the perineural invasion of hilar cholangiocarcinoma and distribution of nerve plexuses around hepatic portal. Methods Pathological sections from 68 patients with hilar cholangiocarcinoma were observed by microscope and the distribution of nerve plexuses in normal hepatoduodenal ligament was analyzed based on the observation of 40 histological sections from 5 autopsy cases. Results Perineural invasion of hilar cholangiocarcinoma occured in 62 patients. The lymph node metastasis and serum CA19-9 levels had no significant effect on perineural invasion （ u =0.878, P 〉0.05 ）. There was no significant difference among the incidences of perineural invasion in well, moderately and poorly differentiated adenocarcinoma groups （Х^2 = 0. 614, P 〉 0.05 ）. Five patterns of perineural invasion were observed and 3 nerve plexuses in the hepatoduodenal ligament and Glisson sheath were found. Conclusions The incidence of perineural invasion of hilar cholangiocarcinoma is high. Nerve plexuses in adventitia should be divested completely during the radical excision of hilar cholangiocarcinoma.