肝门部胆管癌神经浸润的病理学分析及临床意义探讨

Clinical Pathology Research on Perineural Invasion in Hilar Cholangiocarcinoma

目的分析肝门部胆管癌神经浸润的发生率、方式与规律及影响因素。方法光镜下观察52例肝门部胆管癌患者的484张组织病理切片,分析肿瘤神经浸润的发生率、方式与规律;使用关联分析统计学方法分析神经浸润与淋巴结转移、血清CA19-9水平、血清CEA水平、血清总胆红素水平和肿瘤侵犯胆管壁程度的关系。结果肝门部胆管癌神经浸润总发生率为90.38%(47/52);高、低及未分化腺癌间神经浸润发生率比较差异均无统计学意义(P>0.05)。神经浸润发生率与患者的肿瘤Bismuth-Corlette分型、血清CA19-9水平、血清CEA水平、血清总胆红素水平及淋巴结转移均无关(P>0.05),而与胆管壁浸润程度有关(P<0.01)。肿瘤浸润神经主要有4种方式,其发生率由高至低依次是:Ⅱ型>Ⅲ型>Ⅳ型>Ⅰ型。浸润方式与肿瘤分化程度有关(χ2=31.04,P<0.01)。结论肝门部胆管癌具有神经亲嗜性,神经浸润发生率高;肝门胆管癌神经浸润有多种浸润方式,浸润方式与肿瘤分化程度有关;肿瘤是否浸润神经与淋巴结转移、肿瘤分化程度无关,而与侵犯胆管壁程度有关。

Objective To summarize the incidence, patterns and laws of perineural invasion, and explore the path and the influencing factors of perineural invasion in hilar cholangiocarcinoma. Methods A clinicopathologic study was conducted on sections from 52 patients with hilar cholangiocarcinoma to summarize the incidence and patterns of perineural invasion. The relationship of perineural invasion to lymph node metastasis, serum CA19-9, CEA, total bilirubin（TBIL） level, Bismuth-Corllet classification, or tumor penetration depth of bile duct walls was analyzed by association analysis. Results The overall incidence of perineural invasion was 90.38%（47/52）. However, the incidences of perineural invasion had no significant differences among various differentiated adenocarcinoma groups（P〉0.05）. The incidences of perineural invasion were not correlated with the lymph node metastasis, serum CA19-9, CEA, TBIL level,and Bismuth-Corlette classification（P〉0.05）, which was correlated with the tumor penetration depth of bile duct walls（P〈0.01）. There were four patterns of perineural invasion, sequenced them according their incidences from high to low as follows： type Ⅱ 〉type Ⅲ 〉type Ⅳ 〉type Ⅰ. The pattern of perineural invasion was correlated with the degree of tumor differentiation（χ^2=31.04,P0.01）. Conclusions The incidence of perineural invasion is very high in hilar cholangiocarcinoma. The patterns of perineural invasion are similar in the same patient, and a variety of invasion patterns might coexist. While the pattern of perineural invasion is correlated with the degree of tumor differentiation. The incidence of perineural invasion is correlated with the tumor penetration depth of bile duct walls.