大鼠胆汁性肝硬变形成过程光镜和电镜观察

用光镜、透射电镜分别观察大鼠胆总管结扎术后1～86d肝脏,与正常者对照,发现实验组肝脏在出现变性、坏死、渗出、炎细胞浸润、增生直至肝硬变形成等诸多病理改变中,以“小胆管样上皮细胞”的出现,增殖及其分化和小胆管增生为主要病变特点,且贯穿病变始终。推测“小胆管样上皮细胞”参与胆汁性肝硬变的形成。     

周围型肝内胆管细胞癌的CT诊断及鉴别

周围型肝内胆管细胞癌起源于肝内胆管的上皮细胞，是原发肝癌的少见类型。其影像、病理及临床表现均与肝细胞癌有所不同，为进一步提高周围型肝内胆管细胞癌的CT诊断及鉴别诊断水平，本文收集了近年来经手术病理证实的周围型肝内胆管细胞癌10例，着重分析其CT表现，找出CT特征，加深对此病的认识。     

经胆管192Ir内照射对犬胆管周围肝组织放射损伤的实验研究

目的:通过研究经胆管192Ir内照射(192Ir-internalirradiation,192 Ir-IIR)对胆管周围肝组织放射损伤,探讨经胆管192 Ir-IIR的有效治疗范围。方法:实验动物为雄性健康杂种犬4只,体重25~30kg。经手术将施源管植入胆管,根据预先设定的剂量及照射点进行胆管内近距离照射。放射源采用192Ir。内照射10天后处死动物,距离胆管壁由近及远按设计距离分别取1mm×1mm×1mm大小肝组织,常规制备光镜切片,作TUNEL染色;同时常规制备电镜切片。光镜下观察周围肝组织的放射损伤同时计数凋亡肝细胞。电镜下观察肝组织超微结构损伤变化并计数凋亡肝细胞。结果:在胆管最大耐受剂量50Gy时,距胆管15mm内肝细胞核出现不可逆性改变。结论:距放射源15mm可以作为有效治疗范围。     

经胆管192Ir内照射对胆管、肝脏放射损伤的实验研究

目的 探讨经胆管192Ir内照射的安全性、可行性以及有效治疗范围,为肝门部胆管癌经胆管192Ir内照射提供理论依据.方法 取雄性健康杂种犬16只,据照射剂量随机分成4组,每组4只.内照射前从犬肝边缘切取1 cm3大小肝组织作对照研究.术中将近距离治疗施源器经胆囊送入胆囊管与肝总管汇合处并用金属夹固定,根据预先设定的剂量进行胆管内照射.10 d后处死动物,取被照射胆管中央部分长约5 mm胆管,及距离胆管壁由近及远按设计距离分别取1 mm3大小肝组织,制备光镜切片,作HE染色;同时用2.5%戊二醛固定后常规制备电镜切片.光镜下观察胆管及周围肝组织的放射损伤并对损伤程度评分.电镜下观察肝组织超微结构损伤变化并计数凋亡肝细胞.结果 经胆管192Ir内照射30 Gy时,胆管损伤达部分肌层;50 Gy时,胆管仅存外膜;60 Gy时,胆管出现全层坏死.胆管周围肝组织放射损伤随剂量增加而加重.在胆管最大安全耐受剂量50 Gy时,距胆管0～15 mm处肝细胞核出现不可逆性改变.结论 正常胆管对192Ir内照射有良好的耐受性.在胆管最大安全耐受剂量50 Gy时,经胆管192Ir内照射有效的治疗范围可达15 mm.     

基层医院腹腔镜胆囊切除术中预防胆管损伤的体会

我院自１９９６年９月开展腹腔镜胆囊切除术以来,已完成３００例,无一例胆管损伤,现就其体会报告如下。１　腹腔镜胆囊切除术胆管损伤最常见的原因［１］１．１　Ｃａｌｏｔ三角区粘连严重,解剖不清,胆囊周围结缔组织增生或组织水肿及粘连,导致分离三角区困难,误将肝外胆管当成胆囊管而损伤。１．２　术中因用电凝分离切割钩误伤胆总管或肝总管。１．３　因与肝管粘连,强行分离损伤肝总管。１．４　因切割胆囊或切断胆囊管时钛夹导电致胆囊管及肝总管坏死,或钛夹接触到肝管而因导电灼伤,术后渐坏死穿孔。１．５　胆管解剖变异,误…     

肝脏疾病影像学诊断与鉴别诊断(Ⅲ) 肝脏病变的影像学诊断与鉴别诊断(下)

<正>4伴中央疤痕的肝脏病变肝脏中最常见的伴中央疤痕的病变是局灶性结节增生(FNH)、血管瘤(大、海绵样)和纤维板层肝细胞癌(fibrolamellar carcinoma,FLC),其次有胆管细胞癌     

Gd-EOB-DTPA增强MRI诊断肝局灶性结节增生的价值

肝局灶性结节增生(focal nodular hyperplasia,FNH)为肝脏较为少见的良性肿瘤样病变,组织学上由肝细胞、胆管、Kupffer细胞和中间的纤维间隔构成.出血、坏死、恶变等并发症极其罕见,临床上一般不做特殊处理,所以正确的影像诊断很重要.本文通过分析FNH在平扫及钆塞酸二钠(gadolinium ethoxybenzyl diethylene triamine pentaacetic acid,Gd-EOB-DTPA,商品名:普美显)增强MRI动态三期及肝胆期的表现特征,探讨Gd-EOB-DTPA增强MRI对FNH的诊断价值.     

肝局灶性结节增生的CT诊断

肝局灶性结节增生又称结节性肝细胞增生简称FNH、是少见的一种良性占位病变，好发于青年女性和婴幼儿。FNH没有恶变倾向，组织学上主要由形态大致正常的肝细胞团和胆管组成。分析我院1例，现报告如下，旨在提高对本病的认识和鉴别诊断。     

肝外胆管梗阻病变CT诊断的评价

目的：通过分析良恶性肝外胆管梗阻病变的ＣＴ表现，总结出有鉴别诊断意义的征象。材料与方法：复查分析经手术和病理证实、术前均做了ＣＴ检查的肝外胆管梗阻病变１１７例，良性３８例，恶性７９例。结果：肝外胆管远段梗阻，梗阻部胆管呈漏斗样改变，肝外胆管壁呈环形弥漫型增厚，肝内胆管呈竹节状或小囊状轻、中度扩张，梗阻部肿块内钙化，边界清楚对良性病变诊断有重要意义；肝外胆管中、近段梗阻或肝外胆管未显影者，梗阻部胆管呈截断型或突然狭窄型并伴肿块，肝外胆管壁呈环形局限型增厚，肝内胆管呈藤状或蟹足状中度或重度扩张，梗阻部肿块边界不清，其内可见坏死等征象，高度提示恶性病变。结论：良恶性肝外胆管梗阻病变均有其特征性的ＣＴ征象，注意观察胆管的形态改变，以及与周围组织结构关系，并紧密结合临床综合分析，有助于提高诊断准确性。     

慢性活动性乙型肝炎肝细胞内病毒抗原分布与肝细胞损伤和血液检出的相关性研究

经肝脏活检标本病理和实验室证实的30例慢性活动性乙型病毒性肝炎病人,轻型病理变化(以肝小叶周边碎屑样坏死为特征)22例,中型(以肝小叶桥形坏死为特征)3例,重型(整个肝小叶结构明显破坏为特征)5例。经肝细胞免疫组织化学检测证实:HBsAg在肝细胞内的分布与肝细胞病理损伤程度呈负相关。病     

去胆管肝叶肝组织形态及功能变化的实验研究

目的观察大鼠肝叶胆管栓塞结扎后肝细胞形态及功能的变化,探讨去胆管肝叶的保留价值。方法应用氰基丙烯酸酯对仅保留肝右叶和方叶的大鼠行右叶胆道栓塞并结扎,制备去胆管肝叶,肝方叶不处理或行门静脉结扎作去门脉肝叶自身对照。通过分肝静脉血化验检查、组织学观察探讨肝细胞形态及功能的变化。结果与假手术对照组及自身未处理肝叶相比,去胆管肝叶萎缩不明显,超微结构变化不大。透射电镜观察发现去胆管肝叶肝细胞富含线粒体、核糖体及粗面内质网。PAS染色显示肝糖原代谢也无明显差别。分肝静脉血白蛋白及纤维蛋白原含量无明显减低。结论去胆管肝叶在观察期内无明显纤维化,仍保留有肝细胞蛋白质合成、分泌及营养物质代谢功能,提示去胆管肝叶具有保留价值。本实验为临床特殊情况下结扎或切除胆管而保留相应的肝脏组织提供了理论基础。     

薄层色谱法鉴定蓝狐胆汁及其牛磺熊去氧胆酸对四氯化碳肝损伤的保护作用

 目的 确定蓝狐胆汁的药理作用。方法 取30只昆明种小鼠,分为5组,每组6只。分别为:(1)空白组,非肝损伤处理,投喂蒸馏水,注射无伤害性的豆油;(2)模型组,肝损伤处理,不投喂任何药物,完全为四氯化碳(CCL₄)急性肝损伤个体;(3)阳性组,肝损伤处理,投喂护肝片,0.4 g/kg;(4)高剂量组,肝损伤处理,投喂高剂量蓝狐胆汁粉,10 g/kg;(5)低剂量组,肝损伤处理,投喂低剂量的蓝狐胆汁粉,5 g/kg。首先用TLC法研究蓝狐胆汁成分中是否含有熊胆特有成分——牛磺熊去氧胆酸(UDCA),其次研究其胆汁对小鼠CCL₄肝损伤是否有保护作用。结果 对比蓝狐胆汁与熊胆汁,两者的相似度约50%, 两者共四类物质中,有两类相同,蓝狐胆汁中含有UDCA成分。实验动物的肝脏被CCL₄损伤之后,血清中的AST、ALT浓度明显增高,模型组与空白组对比,差异有统计学意义(P<0.05)。通过药理结果及病理切片,可以看到具有抑制CCL₄,造成急性肝损伤小鼠AST、ALT浓度降低的作用。结论 蓝狐胆汁对损伤的肝细胞有修复意义,对肝脏有明显的保护作用。     

Transjugular Intrahepatic Portosystemic Shunt: Histologic and Immunohistochemical Study of Autopsy Cases

Purpose: To assess the histologic findings associated with stenosed and occluded transjugular intrahepatic portosystemic shunt (TIPS) tracts. Methods: Four TIPS tracts within three autopsy livers were histologically studied for vascular components by routine staining and immunohistochemical staining. TIPS had been performed for bleeding from esophageal varices in patients with cirrhosis of the liver. Results: Two TIPS, examined on days 4 and 53, showed occlusion by fibrin thrombus. In the former, no endothelial cells were detected, but coagulative necrosis of hepatocytes was found in the surrounding liver. In the latter, bile pigments were seen on the luminal surface. In the two other TIPS without tract occlusion, examined on days 49 and 293, a layer of endothelial cells, proliferation of smooth muscle cells, and deposition of an extracellular matrix such as collagen were confirmed. In the tract examined on day 293, there was protrusion of hepatocytes into the lumen through the stent wires. Conclusion: Short- and midterm TIPS occlusions were caused by thrombus forming after necrosis of hepatocytes and bile leakage, respectively. Long-term TIPS stenosis was associated with a combination of pseudointimal hyperplasia and ingrowth of hepatocytes. Received: 0/00/00/Accepted: 0/00/00     

大鼠肝干细胞体外诱导分化的实验研究

目的 分离成体大鼠肝干细胞,观察体外培养条件下肝干细胞分化为肝细胞和胆管细胞的过程以及形态学变化.方法 采用AAF/PH肝干细胞刺激模型,通过胶原酶Ⅳ分步消化分离和Percoll梯度离心纯化的方法得到肝干细胞,联合应用地塞米松、DMSO和EGF、HGF、SCF等生长因子诱导肝干细胞增殖并分化为肝实质细胞.结果 分离得到的肝干细胞呈卵圆型,直径是肝细胞的1/4～1/6,免疫荧光检测显示其表达c-kit和OV6两种干细胞抗原,PCR分析显示其表达CK19和白蛋白mRNA.体外诱导培养条件下细胞首先分化成大而圆的成熟肝细胞,继而出现分支样的胆管细胞,而且可见从卵圆形细胞到成熟肝细胞的中间变化过程.结论 新分离的肝干细胞同时表达c-kit、OV6、CK19和白蛋白多种抗原,诱导分化条件下可见从体积较小的卵圆形肝干细胞到体积大许多倍的肝细胞的形态学变化过程.     

Hepatocyte-mediated transport to the bile of AMI-HS, a particulate contrast agent

RATIONALE AND OBJECTIVES: The elimination of hepatocyte-directed particulate contrast agents has not been studied in the same detail as particles eliminated mainly by the mononuclear phagocyte system. The aim of the present study was to elucidate the fate of these particles by a multidisciplinary approach. METHODS: After intravenous injection of AMI-HS particles directed to the hepatocytes, rats were killed and cytological studies, by both electron microscopy and histochemistry, and spectroscopic studies of the bile were performed. The data were compared with a dynamic magnetic resonance study of the heart and liver. RESULTS: The particles were rapidly cleared from the blood by Kupffer cells and hepatocytes and then found first in the vascular and later in the biliary pole of the hepatocytes. After 24 hours, a relaxometric characterization of the bile showed the presence of unchanged particles in the bile. CONCLUSIONS: These results show the capacity of the liver to excrete unchanged AMI-HS particles directly into the bile.     

肝动脉栓塞后肝功能改变及病理基础

目的：探讨单纯全肝动脉末梢栓塞对正常肝组织的影响。方法：用５０～１００ｕｍ明胶海棉微球末梢栓塞１０条犬的全肝动脉，栓后１、３、７、１４和２８ｄ，分别处死１或２条犬，观察组织病理改变，处死前抽血化验肝功能，动态观察肝功能的变化及相应的病理改变。结果：栓后１ｄＧＰＴ、ＧＯＴ及ＡＫＰ升高，超过正常值范围，肝细胞变性、坏死。栓后３ｄＧＰＴ、ＧＯＴ升至高峰，肝细胞变性严重，坏死明显。然后下降，２周后恢复。结论：肝动脉栓塞对肝细胞的急性损害是暂时的     

腹腔镜胆囊切除术中胆道损伤的预防和处理

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)致胆道损伤的原因、预防措施和处理方法。方法对7例LC引起的胆道损伤病例进行回顾性分析。结果7例胆道损伤病例中,术中钛夹误夹闭胆总管1例;3例Mirizzi综合征致胆总管损伤;右肝管损伤2例,其中1例是由于胆囊管变异所致;1例因胆囊颈部粘连严重,分离中在肝门处断离左肝管,并损伤右肝管。所有病例均行胆总管修补或端端吻合术,T管引流获得成功。结论LC引发的胆道损伤应引起足够的重视。发现不及时或处理不当都可能引起严重并发症。术者经验、局部粘连严重和胆道变异是胆道损伤的主要原因。可采用胆总管修补成形、端端吻合术或胆总管空肠Roux-en-Y吻合术治疗胆道损伤。     

Bile duct scarring following ethanol embolization of the hepatic artery: an experimental study in monkeys

Alcohol is a popular embolizing agent, especially in renal tumors and esophageal varices, and results of its use are encouraging. Alcohol embolization of hepatic tumors offers theoretic protection of hepatocytes by portal venous dilution. To verify this, we performed hepatic artery embolization in six adult Rhesus monkeys by alcohol infusion. Although injury to liver cells was minimal, we observed severe damage to intrahepatic bile ducts. Our experience showed that alcohol in the hepatic artery perfused the peribiliary plexus and produced scarring of the bile ducts, resulting in a cholangiographic picture that resembled that of sclerosing cholangitis. Further studies are necessary before alcohol is recommended for hepatic embolization.