肝包虫周围纤维囊壁中骨桥蛋白免疫印记与组化分析

目的:研究肝细粒棘球蚴(肝包虫)周围纤维囊壁中骨桥蛋白(osteopontin,OPN)的表达定位．方法:采用免疫印记法检测OPN在肝细粒棘球蚴(n=48)周围纤维囊壁中的表达,并结合免疫组化方法观察其组织学分布．结果:肝细粒棘球蚴周围纤维囊壁经免疫印记分析80％有OPN表达,形态学观察集中分布于近虫体侧纤维性囊壁(内层),与近肝侧纤维性囊壁(外层)比较有显著差异(75％ vs 8．3％, P<0．05)．结论:OPN参与肝细粒棘球蚴周围内层纤维性囊壁肉芽肿反应的调节．     

骨桥蛋白在肝细粒棘球蚴外囊壁中的表达

目的 研究骨桥蛋白（osteopontin，OPN）在肝细粒棘球蚴外囊壁中的分布及表达。 方法 用免疫组化、免疫荧光双标记法观察60例患者手术切除的肝细粒棘球蚴外囊壁及巨噬细胞中OPN的表达与分布；Von Kossa染色观察囊壁中钙化分布特征。 结果 肝细粒棘球蚴外囊壁中有不同程度OPN表达，75%（45/60）集中分布于近虫体侧纤维囊壁（内层），.3%（5/60）分布于近肝组织侧纤维性囊壁（外层），两者差异有统计学意义（P＜0.01）。在内、外层交界处可见巨噬细胞带，多数巨噬细胞胞浆内有OPN表达。OPN表达阳性的囊壁均合并有不同程度的钙盐沉积，其在囊壁内、外层的分布与OPN的基本一致。 结论 OPN主要分布在肝细粒棘球蚴外囊的内层纤维囊壁。     

肝细粒棘球蚴周围纤维囊壁钙化分布及意义

目的 研究肝细粒棘球蚴周围纤维囊壁（外囊）的钙化分布特征并探讨其意义。方法应用特殊染色观察60例肝细粒棘球蚴外囊壁病理形态特点及钙盐沉着的分布特征．并结合病人血清生化指标及CT观察结果进行分析。结果肝细粒棘球蚴外囊壁中钙盐沉着集中分布于近虫体侧内层纤维性囊壁．且形态各异．与近肝侧外层纤维性囊壁比较有显著差异（P＜0．05）；病人血清钙代谢生化指标均为常值,钙化与非钙化组比较均无显著差异（P均＞0．05）；染色可见部分CT未见钙化的囊壁有钙盐沉着。结论 肝包虫周围纤维性囊壁可分为内层和外层，且各自形成机制不同；钙盐沉积量与内层纤维囊壁形成进程有关。     

Ⅰ、Ⅲ、Ⅳ型胶原在肝包虫囊肿周围人体纤维囊壁中的特异性分层表达

探讨Ⅰ、Ⅲ和Ⅳ型胶原在形成肝包虫囊肿周围人体纤维囊壁中的作用及其临床意义。采用免疫组织化学方法检测Ⅰ、Ⅲ和Ⅳ型胶原在40例肝包虫囊肿周围纤维囊壁中表达。Ⅰ、Ⅲ和Ⅳ型胶原在肝包虫囊肿周围纤维囊壁中出现特异性分层表达。靠近虫体侧纤维囊壁中,Ⅰ、Ⅲ和Ⅳ型胶原的表达阳性率分别为500%、375%和400%。靠近肝实质侧纤维囊壁中,Ⅰ、Ⅲ和Ⅳ型胶原的表达阳性率分别为875%、825%和850%。Ⅰ、Ⅲ、Ⅳ型胶原在两层中表达的差异均有显著意义(P<001,P<001,P<001)。肝包虫囊肿周围人体纤维囊壁分层,Ⅰ、Ⅲ和Ⅳ型胶原与肝实质侧纤维囊壁的形成有密切关系。     

肝囊型棘球蚴囊周肝细胞超微结构观察

用透射电镜观察8例肝脏细粒棘球蚴囊肿周围肝组织及6例正常肝组织的肝细胞超微结构。观察到细粒棘球蚴囊周围肝细胞坏死、萎缩和死亡。肝细胞坏死、萎缩等是肝脏细粒棘球蚴病肝脏损伤的重要基础。     

肝细粒棘球蚴周围纤维囊壁分层研究现状简介

肝包虫病是新疆地区常见的地方性流行性疾病。临床实践、病理组织学观察以及免疫组化等实验证实,肝细粒棘球蚴周围纤维囊壁可分为内外两层——近肝侧的"外膜"层,与近虫体侧的"外囊"层,且两层的形成机制有所不同。     

TGF-β1、TNF-α mRNA在肝包虫囊肿周围人体纤维囊壁中的特异性分层表达

目的探讨TGF鄄β1、TNF鄄αmRNA在形成肝包虫囊肿周围人体纤维囊壁中的作用及其临床意义。方法采用原位杂交方法检测转化生长因子鄄β1(TGF鄄β1)及肿瘤坏死因子鄄α(TNF鄄α)的mRNA在40例肝包虫囊肿周围纤维囊壁中表达。结果TGF鄄β1、TNF鄄α在肝包虫囊肿周围纤维囊壁中出现特异性分层表达。靠近虫体侧纤维囊壁中,TGF鄄β1、TNF鄄α的阳性细胞表达率分别为(10.24±2.90)%、(16.22±2.84)%。靠近肝实质侧纤维囊壁中,TGF鄄β1、TNF鄄α的阳性细胞表达率分别为(37.51±7.45)%、(25.76±5.05)%。TGF鄄β1、TNF鄄α在2层中表达的差异均有显著意义(P<0.01)。靠近肝实质侧纤维囊壁中TGF鄄β1与TNF鄄α之间表达的差异也有显著意义(P<0.05)。结论肝包虫囊肿周围人体纤维囊壁分层,TGF鄄β1、TNF鄄α与肝实质侧纤维囊壁的形成有密切关系。     

肝细粒棘球蚴外囊壁钙化相关受体

目的 比较肝细粒棘球蚴病患者钙化外囊壁及非钙化外囊壁上的钙化相关受体BMPRⅡ(骨形态发生蛋白Ⅱ型受体)、IGF1R(胰岛素样生长因子1受体)和ERα(雌激素受体α)的表达差异。方法 钙化外囊壁和非钙化外囊壁茜素红染色,Envision免疫组化法和qRT-PCR分别检测同一细粒棘球蚴病患者钙化外囊壁及非钙化外囊壁上钙化相关受体BMPRⅡ、IGF1R和ERα的表达水平和钙化相关受体的mRNA表达量。结果 与细粒棘球蚴非钙化外囊壁相比较,同一患者钙化外囊壁茜素红染色钙化显著,且差异有统计学意义(χ²=20.369,P<0.01);钙化外囊壁相关受体的表达明显增加,且差异有统计学意义(P<0.05),mRNA表达量明显增高且差异具有统计学意义(P<0.05)。结论 肝细粒棘球蚴病患者钙化外囊壁钙化相关受体表达量较高,钙化相关因子通过与受体BMPRⅡ、IGF1R和ERα等结合,引起细粒棘球蚴外囊壁钙化,外囊壁的钙化可以有效地抑制细粒棘球蚴的生长,在细粒棘球蚴病患者临床治疗过程中发挥着重要作用。     

绵羊牦牛棘球蚴囊液及囊壁抗原的SDS—PAGE分析

本文应用十二烷基硫酸钠—聚丙烯酰胺凝胶电泳(SDS-PAGE)对绵羊、耗牛棘球蚴囊液及绵羊棘球蚴囊壁可溶性粗抗原的蛋白组分进行了分析。使用10％凝胶,采用垂直板型电泳、考马斯亮兰R—250染色进行SDS-PAGE的结果表明,绵羊及耗牛棘球蚴囊液分别含有16及11种蛋白组分,分子量范围分别为270～16.5KD及280～17KD;主带均为8条。绵羊棘球蚴囊壁可溶性粗抗原共显示17条蛋白带,分子量范围245～17KD,主带8条。本项研究为进一步分析分离特异性抗原奠定了基础。     

泡球蚴感染中期小鼠肝脏病灶周围肉芽肿TGF-β1及其受体TβRⅠ和p-Smad2/3的表达及意义

目的观察泡球蚴感染中期BALB/c小鼠病灶周围肉芽肿中转化生长因子(TGF-β1)及其Ⅰ型受体(TβRⅠ)和p-Smad2/3蛋白的表达及意义。方法 8~10周龄雌性BALB/c小鼠随机分为实验组和对照组。将BALB/c小鼠开腹,肉眼直视下肝左叶注射100μl泡球蚴混悬液,建立小鼠肝泡球蚴感染模型,对照组以相同方法注射等量的生理盐水。于造模第12周时处死小鼠,取肝脏组织,4%甲醛固定、石蜡包埋,4μm连续切片,HE和Masson染色,光镜下观察泡球蚴感染病灶周围病理改变和纤维化程度,采用免疫组织化学技术检测肉芽肿TGF-β1、TβRⅠ受体及p-Smad2/3蛋白的表达。结果实验组小鼠病灶周围以形成典型的大小和形状各异的囊泡为主要特征,囊泡外周纤维结缔组织增生明显,存在不同程度的纤维化。囊泡外围肉芽肿TGF-β1、TβRI和p-Smad2/3的显色指数分别为3.90±1.39、3.18±0.95和3.60±0.93,对照组分别为0.28±0.18、0.32±0.18和0.20±0.14,差异均有统计学意义(P均0.01)。结论囊泡外围组织纤维化较重部位TGF-β1、TβRI和p-Smad2/3表达也相应较高,提示TGFβ1/Smad信号通路可能参与泡球蚴感染小鼠病灶纤维化过程。     

高强度聚焦超声波辐照细粒棘球蚴包囊的热效应

目的通过检测高强度聚焦超声波(HIFU)照射棘球蚴包囊后囊液、囊壁、包囊周围肝组织温度和原头蚴死亡率,了解HIFU处理后不同部位的升温效应,探索HIFU杀伤棘球蚴的方法和效果。方法采集感染细粒棘球绦虫的新鲜羊肝,选取囊壁较薄,触摸弹性较好,直径介于10mm到45mm之间的包囊42个。采用随机区组设计的方法分组,对照组用普通超声照射,实验组用200W声功率HIFU直线扫描的方法照射,照射时间分别为2min,4min,6min,8min,10min。照射后立即测定囊液、囊壁、距包囊5mm部位肝组织的温度。抽取囊液、涂片,经台盼兰染色后计数原头蚴的死亡率。结果HIFU照射后,棘球蚴囊壁、囊液、包囊周围肝组织的温度均有升高,其中囊壁的温度升高最为明显,且与囊液、包囊周围肝组织之间有显著差异;囊液中的原头蚴死亡率增加。结论HIFU照射使棘球蚴包囊的囊壁产生明显的升温效应,HIFU照射对原头蚴有杀伤作用。     

手术治疗邻近肝门部肝细粒棘球蚴病效果观察

目的 探讨手术治疗邻近肝门部的肝细粒棘球蚴病的效果。方法 回顾性分析2015年 11月至 2019年1月行外囊完整剥除术、外囊次全切除术及内囊摘除术的 20例共36个邻近肝门部的肝棘球蚴囊肿的手术疗效。结果 4个肝棘球蚴囊肿成功行外囊完整剥除术,30个肝棘球蚴囊肿成功行外囊次全切除术,2个肝棘球蚴囊肿因外囊与肝门血管粘连过于紧密且已经破裂入胆道而行内囊摘除术。肝门部大血管均保存完整,除1例因术前肝棘球蚴囊肿破裂入胆道(行内囊摘除术)而出现术后胆漏以外,余均无残腔并发症发生。结论 对于邻近肝门部的肝细粒棘球蚴病的手术治疗,外囊次全切除术与外囊完整剥除术较传统的内囊摘除术,术后胆漏、残腔感染等并发症发生率相对较低,可优先选择。但是还应根据囊肿的部位、大小及手术中具体情况选择具体的手术方式。     

高吸水性树脂对高强度聚焦超声杀伤肝包虫囊的增强效应

目的 探索高吸水性树脂(superabsorbent resin, SAR)增强高强度聚焦超声(high intensity focused ultrasound,HIFU)热效应的可行性及杀伤棘球蚴内原头节效率。方法 将囊径大小为4.5～5 cm的新鲜肝包虫囊分为6个组。空白(采取普通超声照射,无SAR)对照组(Ⅰ组),空白(采取普通超声照射)对照组(囊内注入半饱和量SAR)(Ⅱ组),空白(采取普通超声照射)对照(囊内注入饱和量SAR)(Ⅲ组);单纯HIFU辐照对照组(Ⅳ组),以单纯HIFU辐照,HIFU照射+ SAR半饱和量辐照(Ⅴ组),HIFU照射+SAR饱和量(Ⅵ)。各照射试验组均采用200 w声功率、点扫的方式照射整个包囊。照射后立即测定距包囊5 mm部位肝组织、囊液、囊壁的温度,并抽取囊液涂片,经台盼兰染色后计数原头节的死亡率。结果 HIFU照射后,棘球蚴囊壁、囊液、包囊周围肝组织的温度均有升高,HIFU+SAR作用组的各测量点温度分别为:囊壁(49±0.87)℃和(55±0.81)℃,囊液(38.9℃±1.02)℃和(44.6±1.82)℃,肝(34.5±0.88)℃和(37.88±0.67)℃,均显著高于单纯HIFU照射组和超声假照组(P<0.05)。HIFU照射各组原头节杀伤率明显高于对照组,各组(从Ⅰ到Ⅵ组)原头节死亡率分别为22.94%、23.11%、24.43%、55.28%、63.4%、74.2%,Ⅳ、Ⅴ组(即SAR协同HIFU照射)原头节杀伤效率高于单纯HIFU照射组,且达囊液饱和状态时,其内原头节杀伤效率高于半饱和状态,差异有统计学意义(P<0.05)。结论 SAR协同HIFU照射能使棘球蚴包囊的囊壁、囊液产生明显的升温效应,协同HIFU杀伤囊液内的游离原头节,SAR的剂量越大,HIFU照射杀伤原头节的效应越强。     

Hydatid cyst of the interventricular septum. Contribution of magnetic resonance imaging]

Cardiac localisation of hydatid cysts is rare representing 0.5 to 2% of all clinical forms of this condition. Hydatid cysts are usually observed in the left ventricle and involvement of the interventricular septum is exceptional. The principal diagnostic and preoperative investigations are serology and imaging by echocardiography and computed tomography, which can give conflicting results. The authors report a case of hydatid cyst of the interventricular septum in which computed tomography was non-contributory whereas echocardiography (the key investigation in all cases of hydatid cyst) associated with nuclear magnetic resonance imaging provided particularly accurate preoperative information. The latter investigation also allowed diagnosis of pulmonary, hepatic, splenic and renal involvement of the disease.     

Primary splenic hydatidosis

Primary extrahepatic hydatid cysts are rare, and primary splenic hydatid cysts even more so, constituting 2% to 3.5% of all hydatid cysts. We report here a case series of isolated splenic hydatid cysts. Case records of 382 adult patients of abdominal hydatid cysts were analyzed; eight of them (2%; aged 23 to 45 years, 5 women and 3 men) had primary splenic hydatid cysts. Seven patients presented with dull dragging pain in the left hypochondrium. Four patients had splenomegaly. Diagnosis was made at ultrasonography and/or contrast-enhanced computed tomography. Enzyme linked immunosorbent assay for hydatid antibodies tested positive in all patients. One patient presented with hemoperitoneum. All patients underwent splenectomy. Primary splenic hydatid cyst is rare but should be considered in patients with cystic lesions of the spleen.     

Intraperitoneal rupture of the hydatid cyst: Four case reports and literature review

BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications due to cyst size,location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract,vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.CASE SUMMARIES Four patients aged between 27 and 44 years(two men and two women) were admitted to our clinic with sudden abdominal pain(n = 4), hypotension(n = 3),and anaphylaxis(n = 2). Three of the perforated cysts were located in the liver,and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzymelinked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention(range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up(range: 25-80 mo).CONCLUSION Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.     

Role of endoscopic intervention in biliary complications of hepatic hydatid cyst disease

OBJECTIVE: Biliary complications of hepatic hydatidosis are often difficult to detect and manage. The aim of this study was to present our experience on the effectiveness of endoscopic treatment modalities in cases of biliary complications of hepatic hydatid cysts. MATERIAL AND METHODS: Over the past 10 years, 15 patients diagnosed with hepatic hydatidosis and manifesting symptoms and signs indicative of biliary involvement were examined by means of endoscopic retrograde cholangiopancreatography (ERCP) in our Gastroenterology Endoscopic Unit; 7 patients had already been operated on for hepatic hydatid cysts; one of them had a concomitant hydatid cyst in the lung. Diagnosis of the disease was based on a combination of ultrasonography (US), computed tomography (CT) and specific immunologic and/or microbiologic studies. RESULTS: Biliary complications of hydatid cysts were detected by ERCP in 9 patients (60%). Eight (88.9%) patients displayed a communication between the hydatid cyst or its residual cavity and the biliary tree; 5 patients had daughter cysts or residual hydatid material within the biliary tree, 1 patient had a biliocutaneous fistula, 1 patient a postoperative biliary leakage and 1 patient had only an opacification of the hydatid cyst during ERCP. In one patient, ERCP showed stenoses of both of the main hepatic ducts due to their compression by the cyst. Jaundice (88.9%), fever (33.3%) and right upper quadrant abdominal pain (88.9%) were the most frequent manifestations. These complications were demonstrated by US and CT imaging in only 25% of the cases. Four patients underwent ERCP before surgery and 5 after surgery. Endoscopic management was successful in all patients, resulting in clearance of the biliary tree, closure of fistulas, stopping of biliary leakage and jaundice remission. No serious endoscopy-related complications were recorded, with the exception of a pulmonary hydatid cyst rupture during ERCP. CONCLUSIONS: This study suggests that endoscopic treatment modalities are helpful and safe methods in the treatment of biliary complications of hepatic hydatidosis before and after definitive surgical management of the hydatid cysts.