CAJ | 학술논문

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100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%,86/100)，增生性改变 (11%,11/100)，腺瘤性息肉(1%,1/100)，腺癌(2%,2/100)，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(73/100) 。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。粘膜病损的增生活性随病理改变程度加重而升高。
목적　료해장기간담관결석대하유담관점막적손해정도급기림상의의。　방법　 이용술중혹술후담도경련속관찰100례간내담관결석환자적담관점막병손급기분포정황，활검주상규병리、면역조화급류식세포학검사，병이5례간문담관암작위대조。　결과　담관점막손해포괄만성염증(86%,86/100)，증생성개변 (11%,11/100)，선류성식육(1%,1/100)，선암(2%,2/100)，담관점막병손출현재결석감돈부위급하행성인류담관개구처，주요시간문구(73/100) 。암배항원(CEA)、증식세포핵항원(PCNA)계수수병리개변정도가중이상승；류식세포검사S기분수(SFP)상승，S+G2/M무명현변화，DNA비정배체주요재저분화선암중검출。　결론　간내담관결석불단대담관결석감돈적구역조성손해，이차영향도하유담관점막。점막병손적증생활성수병리개변정도가중이승고。
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.