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。     

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。     

小鼠细粒棘球蚴不育囊的超微结构观察

用透射电镜观察了小鼠细粒棘球蚴不育囊的超微结构。其囊壁由角皮层和生发膜构成,角度层含有纤维基质和不规则形颗粒,生发膜又可分皮层区和细胞区。在皮层区基部见到线粒体,微毛间见到“吞饮泡”样质膜凹陷;在细胞区主要有皮层细胞、肌细胞、含糖原细胞等,在有的含糖原细胞中还见到“核仁管系统。”     

高强度聚焦超声辐照后细粒棘球蚴囊壁的病理变化

目的 观察细粒棘球蚴囊壁在高强度聚焦超声（HIFU）辐照后的病理改变。方法 采集感染细粒棘球蚴的新鲜羊肝，选取囊壁较薄、触摸弹性较好的细粒棘球蚴30个。采用随机抽样方法等分为3组，每组10个包囊。对照组，用普通诊断超声照射2 min。处理组1和处理组2分别用150 W和250 W声功率对细粒棘球蚴包囊进行沿囊壁多层面的环形扫描，层面间距为5 mm，扫描速度为3 mm/s，照射时间2～10 min（根据包囊大小）。取出照射后先肉眼观察细粒棘球蚴包囊大体改变，后取囊壁组织分别制作病理切片和透射电镜切片，观察其病理改变。 结果 HIFU（250 W）辐照后，细粒棘球蚴包囊剪开处内囊壁立即发生卷曲，剥离出的内囊颜色变白、变硬、透光度降低。病理切片显示，HIFU辐照后细粒棘球蚴的内囊壁上角皮层与生发层大部分发生分离。电镜观察结果显示，HIFU辐照后细粒棘球蚴的角皮层纤维纹理明显改变，生发层细胞发生裂解性破坏。 结论 HIFU沿细粒棘球蚴囊壁的多层面的环形照射可明显损害细粒棘球蚴囊壁。     

人源细粒棘球蚴染色体测定

为鉴定棘球地细胞系及棘球绦虫的遗传分类提供依据，本实验测定了人源细粒棘球拗染色体。从外科手术的包虫病人体内获取棘球蚴原头节和生发层细胞，按染色体的常规制备方法并加以改进，制备染色体标本。通过对141个分裂像的观察分析，结果表明细粒棘球蚴染色体组的染色体数在5～20条之间，14～18条占明显优势。每一核型有一对染色体呈大棒状，似呈中间或亚中着丝粒，其余染色体呈方点状，似呈端着丝粒。本实验建立了适合棘球蚴染色体制备的方法，在国内首次测定了人源细粒棘球蚴染色体。     

卵巢细粒棘球蚴病一例

患者 ,女 ,3 8岁 ,锡伯族 ,农民。与犬有过密切接触史。发现腹部包块 2年 ,伴月经紊乱、尿频。临床上以“卵巢囊肿”收住院。患者既往身体健康。体检 :一般情况良好 ,心肺未见异常。B超显示子宫多发性平滑肌瘤 ,左卵巢囊肿 ,肝胆未见异常。临床行“全子宫及左卵巢囊肿切除术” ,术中见左卵巢囊肿直径 6cm ,病理诊断为左卵巢细粒棘球蚴病 ,子宫多发性平滑肌瘤。细粒棘球蚴病在新疆多见 ,好发于肝、肺等脏器 ,发生于卵巢者较少见[1] 。本病在临床上主要表现为下腹部肿块 ,扪之呈囊性感 ,由于肿块刺激或压迫膀胱、尿道等附近组织器官 ,可出现…     

3126例肝细粒棘球蚴病外科治疗

1974年 7月～ 2 0 0 3年 5月本院共收治肝细粒棘球蚴病 (又称肝包虫病 ) 3 12 6例 ,作者针对肝棘球蚴囊肿的结构类型 ,采取不同的手术方式 ,取得了较好的效果。报告如下。1　临床资料1.1　一般情况　本组 3 12 6例 ,男性 1865例 ,女性 12 61例 ,年龄 6～ 77岁 ,平均 41.5岁。1.2　结构类型　单发单子囊型 172 6例 (5 5 .2 1% ) ,单发多子囊型 480例 (15 .3 6% ) ,多发单子囊型 3 83例 (12 .2 5 % ) ,多发多子囊型 165例 (5 .2 8% ) ,多间隔多房多子囊型 3 72例 (11.90% )。1.3　部位　肝棘球蚴囊肿位于肝右叶 2 2 17例 (70 .92 % ) ,肝左叶 …     

人体细粒棘球蚴的组织化学观察

包虫囊的组织形态学和超微结构，国内已有较多的报道［１－４］，但对包虫囊的组织化学观察尚少报道。作者对手术切除标本进行组织化学染色观察，旨在进一步探讨人体细粒棘球蚴的组织结构及其生物学意义。材料与方法受检对象为我院１９８１－１９９４年经手术证实的包虫病...     

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．     

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。     

Endoscopic management of intrabiliary-ruptured hepatic hydatid cyst.

BACKGROUND/AIM: Intrabiliary rupture of hepatic hydatid cyst causes serious morbidity and mortality. These patients are usually managed surgically. We evaluated the feasibility and outcome of an alternative method of treatment of these patients. METHODS: Seven patients with ruptured hepatic hydatid into the biliary tract underwent endoscopic treatment consisting of endoscopic sphincterotomy, cyst material extraction and hypertonic saline lavage via nasocystic catheter. RESULTS: Median age of patients was 40 years (range 17-50 years) with a male:female ratio of 2:5. Abdominal pain, jaundice and fever were seen in all patients. Six out of seven patients were positive for hydatid serology. All patients were successfully treated by endoscopic sphincterotomy, clearance of cyst material and hypertonic saline lavage. On a follow-up of 6 months to 4 years (median, 3.5 years), ultrasonography, computed tomography of the abdomen and magnetic resonance imaging of the abdomen showed a complete cure. There were no complications related to procedure. CONCLUSIONS: This study demonstrates endoscopic treatment as one of the therapeutic options of ruptured hepatic hydatid cyst into the biliary tract.     

Ruptured hydatid cyst in a patient with shock

Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination wit...     

Endoscopic management of hepatic hydatid cyst with biliary communication

Background and Aim: A serious complication of hepatic hydatid cyst disease is communication between the cyst and the biliary tree. Surgical management of biliary fistulas is associated with high morbidity and mortality. We carried out a prospective study of endoscopic management of hydatid cysts communicating with bile ducts in 28 patients. Methods: Presence of biliary fistula was suspected by jaundice and/or persistent external biliary fistula after surgical excision and was confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Patients underwent endoscopic sphincterotomy, and either biliary stenting or nasobiliary drainage. Nasobiliary drains were removed when bile leakage stopped and closure of the fistula was confirmed by cholangiography; stents were removed after 4–6 weeks. Results: Of 120 patients with hepatic hydatid cyst seen over a 10‐year period, 28 patients developed fistula between the hepatic hydatid cyst and intrahepatic bile ducts (right intrahepatic bile ducts in 20 patients, left intrahepatic bile ducts in eight patients). Nine of 28 patients had persistent external biliary fistula after surgery. Ten patients showed membranes in bile ducts on cholangiography. We carried out either sphincterotomy with insertion of a nasobiliary drain (n = 6) or sphincterotomy with biliary stenting (n = 22). In 10 patients, the membranes were removed from bile ducts during ERCP. Fistulas healed in all patients after a median time of 11 days (range 5–45 days) after endoscopic treatment. We were able to remove nasobiliary drainage catheters and stents 8–45 days after placement. Conclusions: Endoscopic therapy is an effective mode of treatment for biliary fistulas complicating hepatic hydatid cyst.     

Controversies in the laparoscopic treatment of hepatic hydatid disease

BackgroundLaparoscopic treatment of hydatid disease of the liver can be performed safely in selected patients.MethodsSix hundred and fifty patients were treated for hydatid disease of the liver between 1980 and 2003 at the Hepatopancreatobiliary Surgery Unit of Istanbul Medical Faculty, Istanbul University. Of these, 60 were treated laparoscopically between 1992 and 2000. A special aspirator-grinder apparatus was used for the evacuation of cyst contents. Ninety-two percent of the cysts were at stages I, II or III according to the ultrasonographic classification of Gharbi.ResultsConversion to open surgery was necessary in eight patients due to intra-abdominal adhesions or cysts in difficult locations. There was no disease- or procedure-related mortality. Most of the complications were related to cavity infections (13.5%) and external biliary fistulas (11.5%) resulting from communications between the cysts and the biliary tree. There were two recurrences in a follow-up period ranging between 3.5 and 11 years.DiscussionLaparoscopic treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. Our specially designed aspirator-grinder apparatus was safely used to evacuate the cyst contents without causing any spillage. Knowledge of the relationship of the cyst with the biliary tree is essential in choosing the appropriate patients for the laparoscopic technique. In our experience of 650 cases, the biliary communication rate was as high as 18%; half of these can be detected preoperatively. In the remaining, biliary communications are usually detected during or after surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are helpful to overcome this problem. As hydatid disease of the liver is a benign and potentially recurrent disease, we advocate the use of conservative techniques in both laparoscopic and open operations.     

Usefulness of bubble study in echocardiographic diagnosis of contained rupture of hydatid cyst in the right ventricular outflow tract

We describe an adult female presenting with dyspnea in whom both transthoracic and transesophageal echocardiography detected a mobile sac‐like structure in the right ventricular outflow tract (RVOT) containing a heterogenous echogenic mass. This sac‐like structure markedly changed its shape and size during the cardiac cycle. These findings and the fact that the patient lived in a rural area raised the possibility that this was a hydatid cyst. A bubble study using normal saline was useful in detecting a contained rupture of the cyst. Bubble echoes were noted within the sac‐like structure but did not penetrate the inner wall of the cyst which contained echogenic material, indicating that the rupture was confined only to the outer layers. At surgery, a 0.5 cm communication was noted between the cyst and the RVOT and pathology confirmed the diagnosis of hydatid cyst.     

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.     

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.