肝移植术后胆道并发症的临床及病理分析

目的探讨原位肝移植术后胆道并发症的常见病理组织学及临床特点.方法回顾性分析1998年9月-2005年6月的肝移植术后胆道并发症患者173例（235例次）肝穿刺活组织检查的病理和临床资料.结果肝移植后胆道并发症发生于术后3～2 920 d,其中1～30 d、31～90 d、91～180 d、180 d以后的发生率分别为49.71%（86/173）、17.92%（31/173）、4.62%（8/173）、27.74%（48/173）.炎症类占72.25%（125/173）,行肝穿刺活组织检查171例次;梗阻类占27.74%（48/173）,行肝穿刺活组织检查64例次.病理表现以小叶间胆管上皮细胞变性及炎细胞浸润、汇管区炎症、小胆管增生、汇管区纤维化、小胆管及肝细胞胆汁淤积为主.上述病理表现在炎症和梗阻两类并发症患者中的检出率分别为100.00%（171/171）和100.00%（64/64）、100.00%（171/171）和96.87%（62/64）、9.36%（16/171）和73.44%（47/64）、3.51%（6/171）和79.69%（51/64）、50.29%（86/171）和87.50%（56/64）、63.16%（108/171）和93.75%（60/64）.结论原位肝移植术后胆道并发症以炎症类居多,多发生于术后30 d内,梗阻类多见于术后90 d,预后较差.肝穿刺活组织检查的病理组织学表现在胆道并发症的分类、程度评估及鉴别诊断中具有重要价值.

Clinicopathological analysis of biliary tract complications on post-liver transplantation patients

Objective To analyze the pathohistological changes of the livers and the clinical features of patients with biliary tract complications after their orthotopic liver transplantations. Methods From Sept 1998 to June 2005 clinical and pathological -data of 173 post-liver transplantation patients with biliary tract complications were analyzed. Results Biliary tract complications occurred within 3-2 920 days after the transplantation operations. These complications occurred within 1-30 days, 31-90 days, 91-180 days, 180days at rates of 49.71%, 17.92%, 4.62%, 27.74% respectively. The complications were of inflammatory nature in 171 cases, (72.25%), and of obstructive nature in 164 cases (27.74%). The main pathological changes were epithelium degeneration of interlobular bile ducts, inflammatory cell infiltration in portal areas, proliferation of interlobular bile ducts, fibrosis in portal areas, cholestasis in small bile ducts and hepatocytes. Conclusion Many of the biliary tract complications of post-liver transplantation in our cases were of inflammatory nature and they often occurred within 30 days after the surgery. Obstructive nature complications often occurred in 90 days after the surgery and the prognosis of these cases was much poorer. The pathological changes of live tissues shown in liver biopsies are important for prognostic evaluation, differential diagnosis and categorization of biliary tract complications.