梗阻性黄疸胆汁中胆管脱落细胞研究.DOCVIP

临床医学论文-梗阻性黄疸胆汁中胆管脱落细胞研究 ?????????? 作者：蔡磊 曲强 何小东 周立 张晋夏? 【摘要】? 目的 建立梗阻性黄疸患者胆管引流胆汁中脱落细胞收集方法，比较胆管良性病变及恶性肿瘤胆管脱落细胞特征。方法 从临床收集64例梗阻性黄疸患者引流胆汁，分离提取有核细胞，比较胆管结石和胆管癌病例胆管脱落细胞数量。涂片或应用瑞姬双染法染色后观察不同病例胆管脱落细胞形态。结果 梗阻性黄疸胆汁引流中可收集到大量胆管脱落细胞。胆管癌病例胆管脱落细胞数量显著多于胆管结石病例，分别为(4.70±0.82)×103个/ml和(3.80±0.98)×102个/ml(P0.01)。胆管癌和胆管结石脱落细胞形态学观察均具有明显特征。结论 梗阻性黄疸胆管引流胆汁中存在较大量具有形态学特征的脱落细胞。这些细胞可以作为临床鉴别诊断的重要依据，也是在细胞和分子水平探讨胆管癌发生机制的可靠途径。 【关键词】? 胆管脱落细胞； 胆管癌； 胆管结石； 梗阻性黄疸 ????? 【Abstract】? Objective? To set up a method for collecting biliary cells in the bile drainage in patients with obstructive jaundice and compare the characteristics of cells between benign and malignant biliary cancer. Methods? The bile drainages from 64 patients with obstructive jaundice were collected for extracting the biliary cells. Then, the cell number in the bile drainages from cholangiolithiasis was compared with that in the bile drainage from cholangiocarcinoma. The cell morphology was observed by cell smear or WrightGiemsa′s staining. Results? A considerable number of biliary cells were collected from the bile drainage. The cells in the bile drainage of patients with cholangiocarcinoma were (4.70±0.82)×103/ml, which was significantly more than (3.80±0.98)×102/ml in the bile drainage of those with cholangiolithiasis (P0.01). The morphology of cells from cholangiocarcinoma or from cholangiolithiasis was distinguishable. Conclusions? There exist large number of castoff cells? with morphological characteristics in the bile drainage of obstructive jaundice. They can be used as important basis for clinical differential diagnosis and as a reliable pathway of understanding mechanism of cholangiocarcinogenesis at cellular and molecular levels. ??? 【Key words】? Biliary cells;? Cholangiocarcinoma;? Cholangiolithiasis;? Obstructive jaundice ??? 梗阻性黄疸在外科临床上常见。胆管结石和胆管癌是导致梗阻性黄疸的主要病因。经胆汁引流进行胆管脱落细胞的细胞学检查，是近年来逐渐开展的诊断技术。多种非手术获取细胞方法已被应用，如经PTCD、ERCP引流胆汁或同时采用细胞刷取、组织钳夹等技术［1］。但是，受胆汁引流量较少或操作技术限制，目前对病理状态下胆管脱落细胞数量和形态缺乏整体认识， 细胞学诊断鉴别良恶性病变敏感性和稳定性较差。本研究在改进胆汁