Zhan Jiang-Hua, Hu Xiao-Li, Dai Chun-Juan, Niu Jun, Gu Ji-Qing
Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin 300000, China.
Hepatobiliary Pancreat Dis Int. 2004 Feb;3(1):120-3.
Choledochal cyst, an isolated defect unrestricted to the bile duct, is more appropriately regarded as the sentinel feature of a constellation of anomalies affecting the pancreatobiliary system. This study was to assess the relationship between the expression of inducible nitric oxide synthase (iNOS) and the p53 gene as well as the pathogenesis of choledochal cysts.
iNOS and p53 were detected by immunohistochemistry staining in 26 patients with congenital choledochal cysts. Histopathologically, hyperplasia of the mucosa of the cysts and the amylase level in the bile were also investigated.
Patients with a high level of amylase in the bile had higher expression of iNOS than those with a low level of amylase. p53 protein was expressed neither in fusiform type nor in cystic type. The incidence of mucosal hyperplasia was significantly higher in the fusiform type than that in the cystic type.
Higher expression of iNOS may participate in hyperplasia and carcinogenesis of the mucosa of choledochal cysts. The regurgitation of pancreatic juice into the biliary system might induce mucosal hyperplasia of the biliary tract and inflammatory reaction. In preventing regurgitation-caused hyperplasia and malignancy of the bi-liary tract, early surgery is important for children with congenital choledochal cysts.
胆总管囊肿是一种不限于胆管的孤立性缺陷，更恰当地被视为影响胰胆管系统的一系列异常的哨兵特征。本研究旨在评估诱导型一氧化氮合酶（iNOS）和p53基因的表达与胆总管囊肿发病机制之间的关系。
采用免疫组织化学染色法检测26例先天性胆总管囊肿患者的iNOS和p53。在组织病理学上，还研究了囊肿黏膜增生和胆汁中的淀粉酶水平。
胆汁中淀粉酶水平高的患者iNOS表达高于淀粉酶水平低的患者。梭形型和囊肿型均未表达p53蛋白。梭形型黏膜增生的发生率明显高于囊肿型。
iNOS的高表达可能参与胆总管囊肿黏膜的增生和癌变。胰液反流至胆道系统可能诱发胆道黏膜增生和炎症反应。对于先天性胆总管囊肿患儿，早期手术对于预防反流引起的胆道增生和恶变很重要。
