肝移植术供体肝脏及其肝穿活检临床病理观察分析

Clinicopathological observation and analysis of donor liver and biopsy in liver transplantation

目的探讨肝移植术时供体肝脏的病理组织学变化与其移植术后肝脏病理改变的关系以及对预后的影响。方法该研究对87例肝移植术供肝零时活检和术后肝脏活检标本进行病理组织观察分析。结果（1）87例供肝零时活检肝细胞变性100％；（2）肝窦内皮细胞损伤41．3％；（3）肝细胞脂肪变性18．3％；（4）肝细胞坏死10．3％。结论供肝肝细胞变性最常见，大多可逐渐恢复。肝窦内皮细胞损伤是观察缺血再灌注损伤的重要指标。中到重度小泡性肝细胞脂肪变是可用的。肝移植术后肝细胞坏死有逐渐加重、范围逐渐增大的趋势时，可使移植肝功能丧失的危险性增加。肝移植术零时供肝活检及术后肝活检的对比观察具有十分重要的诊断价值。

Objective To investigate the relationship between histopathological changes of donor liver and those after liver transplantation and explore its effects on prognosis. Methods The histopathological changes of donor liver and post-transplantation live biopsy were observed in 87 cases. Results The percentage of hepatic degeneration at immediate biopsy of donor liver was 100%, the in jury of sinusoid endothelial cell accounted for 41.3%, the hepatic steatosis for 18.3% and the necrosis of liver cells for 10.3%. Conclusion Most of the pathological changes of the donor liver during and after liver transplantation are reversible. The damage of the hepatic sinusoidal cells is the important criterion for the observation of ischemia reperfusion injury. Moderate and heavy hepatic steatosis can be used in the liver transplantation. After liver transplantation, if the necrosis of liver cells gradually gets serious, the risk of transplanted liver losing its function gets bigger, so the comparative observation has very important value in diagnosis.