肝内胆管结石的下行性胆管粘膜损害

The downward mucosa lesions of the bile duct in hepatolithiasis

目的 了解长期肝胆管结石对下游胆管粘膜的损害程度及其临床意义。方法 利用术中或术后胆道镜连续观察 10 0例肝内胆管结石患者的胆管粘膜病损及其分布情况 ,活检做常规病理、免疫组化及流式细胞学检查 ,并以 5例肝门胆管癌作为对照。结果 胆管粘膜损害包括慢性炎症 (86 % ,86 / 10 0 ) ,增生性改变 (11% ,11/ 10 0 ) ,腺瘤性息肉 (1% ,1/ 10 0 ) ,腺癌 (2 % ,2 / 10 0 ) ,胆管粘膜病损出现在结石嵌顿部位及下行性引流胆管开口处 ,主要是肝门区 (73/ 10 0 )。癌胚抗原 (CEA)、增殖细胞核抗原 (PCNA)计数随病理改变程度加重而上升 ;流式细胞检查S期分数 (SFP)上升 ,S +G2 /M无明显变化 ,DNA非整倍体主要在低分化腺癌中检出。结论 肝内胆管结石不但对胆管结石嵌顿的区域造成损害 ,而且影响到下游胆管粘膜。

Objective To evaluate the down stream mucosa lesions of the bile duct in hepatolithiasis.Methods The macromorphological and microscopic alterations of the bile duct mucosa in 100 consecutively admitted patients with hepatolithiasis were studied by intra or postoperative cholangioscopy. The biopsy specimens were examined with immunohistochemistry and flow cytometry (FCM) to determine the proliferative activity and DNA content. Five cases of cholangiocarcinoma were used as control.Results Chronic cholangitis was found in 86%(86/100), proliferative lesions in 11%(11/100), adenomatous polyps in 1%(1/100) and adenocarcinoma in 2%(2/100).Severe mucosa lesion associated with hepatolithiasis was found in stone impacted region as well as in down stream bile duct. The intensity of CEA stain and PCNA index increased in direct proportion to bile duct lesions. Aploid type of DNA presented in 80% of high degree malignant adenocarcinoma cases.Conclusions The severe mucosa lesion associated with hepatolithiasis located not only in stone impacted region but also predominantly in down stream bile duct,(74% mucosa lesion in hilar region).The proliferative activity of examined bile duct mucosa lesion increased with pathological deterioration.