CAJ | 학술논문

目的探讨Kasai手术对肝脏病理的影响.方法收集2013年12月至2014年4月胆道闭锁患儿12例行肝脏移植手术时所切除的肝脏标本,根据有无行Kasai手术,分为Kasai手术组和非Kasai手术组.采用Masson和CK19免疫组织化学染色检测肝纤维化和胆管反应程度,结合肝脏大体形态与影像学资料,对肝脏标本相关数据进行统计学分析.12例患儿中Kasai手术组6例,长期自肝生存者2例,年龄为7岁和11岁,其余年龄在7～17个月之间.非Kasai手术组6例,年龄5～8个月.Kasai手术组肝脏标本大体形态可分成两部分:肥厚区和萎缩区,肥厚区均包括肝脏第Ⅳ、Ⅷ段,萎缩区均包括肝脏第Ⅱ段,2例术后长期自肝生存者,肝脏中央呈现为大结节(位于肥厚区).非Kasai手术组患儿肝脏标本呈现均匀硬化,胆汁淤积严重.结果采集两组患儿肝脏第Ⅱ、Ⅳ段肝脏标本,Kasai手术组肝脏第Ⅱ段肝纤维化与胆管反应程度分别为(6.43±1.90)％、(0.61±0.45)％;肝脏第Ⅳ段分别为(9.62±3.58)％、(1.39±0.73)％,非Kasai手术组肝纤维化和胆管反应于肝脏第Ⅱ段分别为(7.30±2.53)％、(2.84±1.37)％;肝脏第Ⅳ段分别为(8.42±2.84)％、(3.08±0.46)％,分别进行统计学分析,组间肝纤维化或胆管反应均无统计学意义(P均＞0.05).Kasai手术组肝纤维化和胆管反应两者差异有统计学意义(肝第Ⅱ段:P=0.014;肝第Ⅳ段:P=0.048);肝脏体积与肝第Ⅳ段肝纤维化呈线性相关性,拟合线性函数为:y=-0.448x+ 1.237,r2=0.665(y代表肝第Ⅳ段的肝纤维化,x代表肝脏体积的对数值).同时,于肝移植术前CT图像分析发现肝脏结构具有差异性.结论 Kasai手术建立了肝外胆汁引流通道,但各肝段胆汁引流程度不一,导致肝脏形态学发生变化,提示Kasai手术中应该尽量解剖范围广泛一些;而且Kasai术后肝脏形态学及病理学检查是没有必然联系的.
목적 탐토Kasai수술대간장병리적영향.방법 수집2013년12월지2014년4월담도폐쇄환인12례행간장이식수술시소절제적간장표본,근거유무행Kasai수술,분위Kasai수술조화비Kasai수술조.채용Masson화CK19면역조직화학염색검측간섬유화화담관반응정도,결합간장대체형태여영상학자료,대간장표본상관수거진행통계학분석.12례환인중Kasai수술조6례,장기자간생존자2례,년령위7세화11세,기여년령재7～17개월지간.비Kasai수술조6례,년령5～8개월.Kasai수술조간장표본대체형태가분성량부분:비후구화위축구,비후구균포괄간장제Ⅳ、Ⅷ단,위축구균포괄간장제Ⅱ단,2례술후장기자간생존자,간장중앙정현위대결절(위우비후구).비Kasai수술조환인간장표본정현균균경화,담즙어적엄중.결과 채집량조환인간장제Ⅱ、Ⅳ단간장표본,Kasai수술조간장제Ⅱ단간섬유화여담관반응정도분별위(6.43±1.90)％、(0.61±0.45)％;간장제Ⅳ단분별위(9.62±3.58)％、(1.39±0.73)％,비Kasai수술조간섬유화화담관반응우간장제Ⅱ단분별위(7.30±2.53)％、(2.84±1.37)％;간장제Ⅳ단분별위(8.42±2.84)％、(3.08±0.46)％,분별진행통계학분석,조간간섬유화혹담관반응균무통계학의의(P균＞0.05).Kasai수술조간섬유화화담관반응량자차이유통계학의의(간제Ⅱ단:P=0.014;간제Ⅳ단:P=0.048);간장체적여간제Ⅳ단간섬유화정선성상관성,의합선성함수위:y=-0.448x+ 1.237,r2=0.665(y대표간제Ⅳ단적간섬유화,x대표간장체적적대수치).동시,우간이식술전CT도상분석발현간장결구구유차이성.결론 Kasai수술건립료간외담즙인류통도,단각간단담즙인류정도불일,도치간장형태학발생변화,제시Kasai수술중응해진량해부범위엄범일사;이차Kasai술후간장형태학급병이학검사시몰유필연련계적.
Objective To explore the effects of Kasai procedure on liver pathology.Methods During December 2013 to April 2014,explanted livers from 12 consecutive children undergoing transplantation for biliary atresia (BA) were examined with a standardized protocol.The specimens were divided into Kasai and non-Kasai groups (n =6 each).Masson and CK19 immunohistochemical staining were used to detect liver fibrosis degree and bile duct reaction.Hepatic morphology and imaging data were used to explore the correlations with liver parameters.In Kasai group,2 cases had better prognosis and their ages were 7 and 11 years respectively and the remainder from 7 to 17 months.Non-Kasai group had an age range of 5 to 8 months.The liver specimens were divided into two parts in Kasai group:hypertrophic and atrophic areas.The former contained liver Ⅳ and Ⅷ segments while the later liver Ⅱ segment.Large central nodules were found in two cases with better prognosis.On the contrary,there were severe bile congestion and even cirrhosis in non-Kasai group.Results The liver Ⅳ and Ⅱ segment specimens were collected and the values of liver fibrosis and bile duct reaction evaluated.In Kasai group,liver fibrosis and bile duct reaction were (6.43 + 1.90)％,(0.61 + 0.45) ％ in liver Ⅱ segment versus (9.62 + 3.58) ％,(1.39 + 0.73) ％ in liver Ⅳ segment.For non-Kasai group,(7.30 + 2.53) ％,(2.84 + 1.37) ％ in liver Ⅱ segment versus (8.42 + 2.84) ％,(3.08 + 0.46) ％ in liver Ⅳ segment.No significant inter-group differences existed in liver fibrosis or bile duct reaction (P＞ 0.05).Significant differences existed between liver fibrosis and bile duct reaction in Kasai group (liver Ⅱ segment:P =0.014; liver Ⅳ segment:P =0.048).Furthermore there was a linear equation between liver volume and liver fibrosis degree in liver Ⅳ segment of Kasai group:y =-0.448x + 1.237,r2 =0.665 (y represented liver fibrosis of liver Ⅳ segment,x value of liver volume with 10 logs base).And pre-transplantation computed tomography (CT) showed some intergroup differences.Conclusions In patients with BA,liver morphology changes after Kasai procedure.It may be due to an imbalance of bile drainage by different segments so that comprehensive anatomy area should be expanded during Kasai procedure.There is no inevitable correlation between liver morphology and histopathology after Kasai procedure.