胆囊炎和胆系结石手术患者肝组织病理分析57例

Liver pathology in patients undergoing surgical treatmentfor biliary calculus or inflammation: Analysis of 57 cases

目的:从肝脏病理组织学角度,探讨在因胆系良性病变手术的患者中,胆囊炎或胆系结石与肝脏损害之间的联系.方法:回顾性分析2012-06-01/2013-05-31因胆囊炎或胆囊结石行胆囊切除术,和因胆管结石行胆管切开取石手术切除的患者共1479例,其中120例因术前临床资料(超声、CT、MRI)或术中发现肝脏形态异常而行肝组织学检查,排除乙型病毒性肝炎、丙型病毒性肝炎、酒精性肝病、药物性肝病、自身免疫性肝病、肝包虫、肝囊肿、肝血管瘤、肝脏及胆道肿瘤,有57例肝脏损伤原因不明.我们对这57例进行了分析及探讨.结果:(1)本研究的胆道手术患者中,大部分病理学上存在肝脏损伤(71.93%),其中肝纤维化者占50.88%;(2)胆囊结石或炎症较胆管结石或炎症,合并脂肪变的显著性增高(47.1%vs17.5%,P<0.05,RR=2.689,95%CI:1.160-6.234;OR=4.190,95%CI:1.196-14.683);(3)脂肪变合并炎症坏死的显著性增高(26.7%vs 7.1%,P<0.05,RR=3.733,95%CI:0.943-14.780;OR=4.727,95%CI:0.917-24.362);(4)糖尿病合并炎症坏死的显著性增高(42.9%vs 8.0%,P<0.05,RR=5.357,95%CI:1.503-19.094;OR=8.625,95%CI:1.408-52.828).结论:本研究从肝组织病理学角度观察这些因胆道疾病行手术切除患者的肝脏损伤特征,结合其临床症状符合非酒精性脂肪性肝病的特点.

AIM： To discuss the cause and effect relationship between biliary calculus or inflammation and liver damage in the patients undergoing surgery for benign biliary system diseases. METHODS： A total of 1479 patients underwentsurgery for calculus of the bile duct, cholangitis, gallstones or cholecystitis from June 1, 2012 to May 31, 2013 at our hospital, of whom 120 underwent surgical liver pathology analysis, because their liver morphology was found to be abnormal by preoperative ultrasound, CT or MRI. There were 57 cases of liver injury for unknown reasons after excluding hepatitis B virus, hepatitis C virus, alcoholic liver disease, druginduced liver disease, autoimmune liver disease, liver hydatid, hepatic cyst, hepatic hemangioma, hepatoma and biliary tract cancer. We analyzed and discussed the possible pathogenesis of these 57 cases. RESU LTS： Most of the patients undergoing biliary tract surgery had pathological liver injury （71.93%）. Liver fibrosis was observed in 50.88% of cases. In comparison with calculus of the bile duct and cholangitis, gallstones and cholecystitis were more easily accompanied by steatosis （47.1% vs 17.53, P 〈 0.05, RR = 2.689, 95%CI： 0.05-6.234; OR = 4.190, 95%CI： 1.196-14.683）. Steatosis was more easily accompanied by inflammatory necrosis （26.7% vs 7.1%, P 〈 0.05, RR = 3.733, 95%CI： 0.05-14.780; OR = 4.727, 95%CI： 0.917-24.362）. Diabetes was easily accompanied by inflammatory necrosis （42.9% vs 8.0%, P 〈 0.05, RR = 5.357, 95%CI： 0.05-19.094; OR = 8.625, 95%CI： 1.408-52.828）. CONCLUSION： In patients undergoing surgical resection for biliary tract diseases, quite a number of them have the clinical symptoms of non-alcoholic fatty liver disease. Therefore, it is necessary to strengthen the assessment of metabolic liver disease, especially non-alcoholic fatty liver disease, before deciding whether to manage biliary calculus or inflammation by surgical methods.