本文選題：膽道閉鎖　切入點(diǎn)：病理　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:研究膽道閉鎖患兒Kasai術(shù)后肝內(nèi)膽管結(jié)構(gòu)病理改變,分析其與膽管炎之間的關(guān)系,并探討Kasai術(shù)后肝門(mén)結(jié)構(gòu)改變與肝內(nèi)病理改變的差異,為臨床分析膽管炎發(fā)生及治療膽管炎以及對(duì)改進(jìn)Kasai手術(shù)提供理論依據(jù)。方法:1、收集膽道閉鎖患兒Kasai術(shù)后行肝移植手術(shù)切除的自體肝臟標(biāo)本16例,作為移植;同時(shí)收集膽道閉鎖患兒行Kasai手術(shù)中肝臟活檢標(biāo)本16例,作為Kasai組。采用HE和免疫組化等技術(shù)分別檢測(cè)匯管區(qū)小葉間膽管直徑、匯管區(qū)管腔數(shù)量;匯管區(qū)小葉間膽管增生分級(jí);匯管區(qū)膽栓分級(jí);炎癥細(xì)胞浸潤(rùn)分級(jí);小葉間膽管板畸形等,收集臨床上膽管炎發(fā)生情況,進(jìn)一步分析其與臨床發(fā)生膽管炎的關(guān)系。2、收集Kasai術(shù)后因膽汁淤積性肝硬化行肝移植手術(shù)的膽道閉鎖患兒13例,因術(shù)后黃疸持續(xù)不退,肝功能進(jìn)行性惡化,膽汁引流情況較差,作為引流不良組,切取肝門(mén)及肝內(nèi)組織。收集3例Kasai術(shù)后退黃情況好,肝功能恢復(fù),逐漸出現(xiàn)肝門(mén)部囊腫,再發(fā)生黃疸而行肝移植手術(shù),作為引流良好組,并于肝腸吻合口處留取肝組織,沿左右肝管分別間隔1 cm連續(xù)取材。結(jié)果:1、移植組與Kasai組自體肝臟標(biāo)本病理比較:術(shù)后膽管直徑增大,開(kāi)放的膽管管腔數(shù)量減少,膽管及膽管上皮增生程度加重,膽栓及炎細(xì)胞浸潤(rùn)程度減輕,可見(jiàn)較多團(tuán)塊型膽管板畸形;移植組膽管管腔數(shù)量明顯少于對(duì)照組,炎細(xì)胞浸潤(rùn)程度明顯低于Kasai組,而膽管上皮增生程度明顯重于對(duì)照組,P0.05,差異有顯著性;移植組患兒肝內(nèi)不同部位膽管病理結(jié)構(gòu)改變:發(fā)現(xiàn)肝左葉膽管損傷最重;右葉膽管損傷最輕,但是炎細(xì)胞浸潤(rùn)較重;肝門(mén)處膽管直徑最大,淤膽最重;移植組膽管直徑總和300μm,Kasai手術(shù)日齡60天,其自體肝生存的時(shí)間相對(duì)較長(zhǎng),肝移植時(shí)間較晚,發(fā)生膽管炎頻次減少,術(shù)后黃疸消退情況較好。2、引流不良組肝內(nèi)病理改變以纖維化加重,膽管增生及血管增生為主,淤膽及炎細(xì)胞浸潤(rùn)較輕,匯管區(qū)可見(jiàn)小的膽汁湖。肝門(mén)纖維化程度嚴(yán)重,尤其可見(jiàn)較多孤立的假小葉,增生的膽管逐漸侵入肝小葉,肝細(xì)胞逐漸退化,肝門(mén)淤膽程度較肝內(nèi)相對(duì)加重;引流良好組從肝腸吻合處逐漸向肝內(nèi)解剖發(fā)現(xiàn):肝左葉炎癥及膽栓程度逐漸減輕,以大膽管為主,開(kāi)放管腔相對(duì)較少,膽管直徑較大,最大為750μm:肝右葉各部位損傷程度無(wú)明顯區(qū)別,膽管增生明顯,開(kāi)放膽管管腔較多,膽管直徑較小,最大為390μm。結(jié)論:膽道閉鎖患兒Kasai術(shù)后匯管區(qū)膽管增生情況,開(kāi)放膽管的直徑等肝內(nèi)膽管病理改變影響術(shù)后膽管炎的發(fā)生頻次,早期行Kasai手術(shù)可以適當(dāng)減輕膽管的損傷,延長(zhǎng)Kasai術(shù)后自體肝生存時(shí)間;Kasai術(shù)后膽汁引流較好的病例均呈現(xiàn)左葉膽管直徑較大,可能提示解剖肝門(mén)廣度需要增加。
[Abstract]:Objective: to study the pathological changes of intrahepatic bile duct structure in children with biliary atresia after Kasai, and to analyze the relationship between them and cholangitis, and to explore the difference between hepatic hilus structure and intrahepatic pathological changes after Kasai. In order to analyze the occurrence and treatment of cholangitis and to provide theoretical basis for improving Kasai operation, 16 autologous liver specimens of children with biliary atresia underwent liver transplantation after Kasai operation were collected as transplantation. Liver biopsy specimens were collected from 16 cases of children with biliary atresia undergoing Kasai operation as Kasai group. The diameter of interlobular bile duct, the number of lumen of portal duct and the grade of intralobular bile duct hyperplasia were detected by HE and immunohistochemical techniques. Bile embolus grade, inflammatory cell infiltration grade, interlobular bile duct plate malformation and so on. The clinical occurrence of cholangitis was collected. The relationship between cholangitis and cholangitis was further analyzed. Thirteen children with biliary atresia underwent liver transplantation for cholestatic cirrhosis after Kasai were collected. As the group of poor drainage, the hilus of liver and the liver tissue were removed. 3 cases of Kasai had good yellow condition after operation, the liver function recovered, the hepatic hilar cyst appeared gradually, and then the jaundice occurred and the liver transplantation was performed, which was used as the good drainage group. The liver tissue was taken from the anastomotic site of liver and intestine, and the liver tissue was collected continuously along the left and right hepatic ducts. Results compared with Kasai group, the diameter of bile duct increased and the number of open bile duct lumen decreased. The degree of hyperplasia of bile duct and bile duct epithelium was aggravated, the degree of infiltration of bile embolus and inflammatory cells was reduced, the number of bile duct lumen in transplantation group was obviously less than that in control group, and the infiltration degree of inflammatory cells in transplantation group was obviously lower than that in Kasai group. The degree of hyperplasia of bile duct epithelium was significantly higher than that of control group (P 0.05). The pathological changes of bile duct in transplantation group were as follows: the bile duct injury of Zuo Ye was the most serious, the injury of right lobe bile duct was the least, but the infiltration of inflammatory cells was serious. The diameter of bile duct at the hilar of liver was the largest and the cholestasis was the most serious, and the total diameter of bile duct in the transplantation group was 300 渭 m Kasai, the survival time of autologous liver was relatively long, the time of liver transplantation was late, and the frequency of cholangitis was decreased. Postoperative jaundice subsided better. The pathological changes of liver in poor drainage group were aggravated by fibrosis, bile duct hyperplasia and vascular hyperplasia, cholestasis and inflammatory cell infiltration were light, small bile lake could be seen in the catchment area, the degree of hepatic hilar fibrosis was serious. In particular, more isolated pseudolobules were observed. The proliferative bile duct gradually invaded the hepatic lobules, the hepatocytes gradually degenerated, and the degree of cholestasis in the hepatic hilus was more serious than that in the liver. In the good drainage group, it was found that the degree of inflammation and bile embolism of the liver Zuo Ye was gradually reduced from the anastomosis of the liver to the intestine, with the bold tube as the main, the opening lumen was relatively small, and the diameter of the bile duct was larger. The maximum was 750 渭 m: the degree of injury in right lobe of liver had no obvious difference, the bile duct hyperplasia was obvious, the open bile duct lumen was more, the diameter of bile duct was smaller, the maximum was 390 渭 m. Conclusion: bile duct hyperplasia in bile duct area after Kasai in children with biliary atresia. The pathological changes of intrahepatic bile duct, such as the diameter of open bile duct, influence the frequency of postoperative cholangitis. Early Kasai operation can reduce the injury of bile duct. Prolonging the survival time of autologous liver after Kasai and good bile drainage after Kasai all showed that the diameter of Zuo Ye bile duct was larger, which might suggest that the breadth of anatomical hepatic hilus should be increased.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R726.5

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本文編號(hào)：1595675