肝脏穿刺活检在诊断移植肝病理改变中的价值

目的研究肝移植术后肝穿刺活检标本的病理变化与特征。方法回顾分析从2004年10月至2005年4月间39例肝脏移植术后患者53例次诊断性肝脏穿刺活组织检查。用HE染色方法显示其病理形态学的改变。结果采用Banff国际排斥反应病理诊断标准及参照临床检查和治疗结果,53例次肝脏穿刺检查分别被诊断为急性排斥16例次、保存性灌注再损伤12例、胆道并发症9例次、药物性肝脏损伤11例次、慢性排斥3例次、急性肝坏死2例。结论保存性肝脏损伤时肝内的小灶性坏死、肝细胞气球样变性及药物损伤所诱导的多形态肝细胞变性是区别急性排斥反应的重要病理特征。早期胆道狭窄通常显示为小胆管的反应性增生和伴有轻度肝细胞损伤的微胆管胆汁淤积。

The value of liver biopsy for pathological diagnosis in liver transplant patients

Objective To evaluate liver biopsy for the diagnosis in liver transplant patients with suspected acute rejection. Methods From Oct. 2004 to Apr. 2005, liver biopsies were performed 53 times in 39 transplant cases. Results Based on Banff schema for grading liver allograft rejection, laboratory abnormalities and result of treatment, acute rejection was diagnosed on 16 episodes, preservation injury in 12, bile duct strictures in 9, drug-induced injury in 11, chronic rejection in 3 and acute hepatic failure in 2. Conclusions Hepatocyte ballooning with necrosis features preservation injury. Drug-induced injury commonly has a combination of hepatocyte denaturalization with mild portal inflammation. Histologic features of early bile duct strictures in liver biopsy show prominent bile ductular proliferation and the canalicular cholestasis with mild hepatocyte damage which help to exclude acute rejection.