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肝移植术后患者胆道并发症的临床病理分析

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

作者信息

Wang Zheng-lu, Zhang Shu-ying, Zhu Cong-zhong, Li Hui, Tang Ying, Shen Zhong-yang

机构信息

Oriental Organ Transplantation Center, First Central Hospital of Tianjin, Tianjin 300192, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2006 Apr;14(4):247-9.

Abstract

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 3-2920 days after the transplantation operations. These complications occurred within 1-30 days, 31-90 days, 91-180 days, 180 days 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.

摘要

目的

分析原位肝移植术后患者肝脏的病理组织学变化及胆道并发症的临床特征。

方法

分析1998年9月至2005年6月173例肝移植术后发生胆道并发症患者的临床和病理资料。

结果

胆道并发症发生于移植手术后3至2920天。这些并发症在1至30天、31至90天、91至180天、180天之后发生的比例分别为49.71%、17.92%、4.62%、27.74%。171例(72.25%)并发症为炎症性质,164例(27.74%)为梗阻性质。主要病理变化为小叶间胆管上皮变性、门管区炎性细胞浸润、小叶间胆管增生、门管区纤维化、小胆管及肝细胞胆汁淤积。

结论

我们所观察病例中,肝移植术后胆道并发症多为炎症性质,且常发生于术后30天内。梗阻性质并发症常发生于术后90天,这些病例预后较差。肝活检显示的肝组织病理变化对胆道并发症的预后评估、鉴别诊断及分类具有重要意义。

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