胆囊结石病理切片诊断华支睾吸虫感染的临床应用

The clinical application of the pathological section of cystic and calculous to diagnose clonorchis sinensis infection

目的探讨胆囊结石病理切片对华支睾吸虫感染的诊断价值。方法在本院2011年10月～2012年6月硬镜微创保胆取石术中取少许胆囊壁组织,抽取胆汁及收集结石标本,对所取胆囊壁进行常规病理检查,主要检测华支睾吸虫卵,胆汁经离心沉渣后镜检虫卵,对结石标本经固定、软化、脱水等特殊处理,制成切片,经特殊染色后镜检,结合免疫组化检查,确诊华支睾吸虫卵。结果 200例胆囊结石患者(广州地区)在保胆取石术后对胆囊壁、胆汁及胆囊结石标本进行上述方法检测。其中,胆囊壁发现华支睾吸虫卵者21例(检出率为10.5%),胆汁检出80例(检出率为40.0%);而胆囊结石检出148例(检出率为74.0%),远远高于前二者(P<0.01),并且在结石切片中看到虫卵周围有黏蛋白样物质包裹虫卵。结论胆囊结石患者在保胆取石术中对胆囊壁活检,对胆汁及结石进行病理分析可诊断华支睾吸虫感染,以胆囊结石病理切片检出率最高,对提高华支睾吸虫感染的诊断率,进一步指导术后治疗,预防结石复发有重要意义。

Objective To discuss the diagnostic value of pathological section of cystic and calculous to diagnose clonorchis sinensis infection. Methods A few gallbladder wall organizations in the rigid gas permeable minimal invasion cholelithotomy were taken in our hospital from October 2011 to June 2012, bile was extracted and the stone specimens were collected, conventional pathologic examination methods were taken to check the gallbladder wall, the main detection was to test ova of clonorchis sinensis, the microscopic examination of the ova of clonorchis sinensis was taken after the centrifugation and sediment, after the fixed, softening, anhydration and the other special processing, the stone specimens was made to slice, and then given the microscopic examination after special staining, the immunohistoehemistry was combined used to make a definite diagnosis of ova of clonorchis sinensis. Results Two hundred cases of cystic and calculous patients （in Guangzhou） were given the above method to detect the gallbladder wall, bile, cystic and calculous samples after the cholelithotomy. A- mong them, there were 21 cases who found with ova of clonorchis sinensis in the gallbladder wall （the rate of detection was 10.5%）, there were 80 eases detected in bile （the rate of detection was 40.0%）; and there were 148 cases detected in cystic and calculous （the rate of detection was 74.0%）, the detection rates in cystic and calculous were far more than before that in the gallbladder wall and bile （P 〈 0.01）, and it could be observed around the ova in the stone slices with the sticky protein kind material packaging the ova. Conclusion Taking intraoperative biopsy gallbladder wall in cystic and calculous patients with cholelithotomy and taking the pathologic analysis to the bile and calculous, can diagnose clonorchis sinensis infection, and the highest detection rate is the pathological section of cystic and calculous, it has important significance in improving the diagnosis rate of clonorchis sinensis infection, further guidance in postoperation treatment and the prevention of the recurrence of calculous.