供肝零时相活检组织学特征及术后早期并发症相关性探究.doc

供肝零时相活检组织学特征及术后早期并发症相关性探究 　 作者：程龙 阎晓初 冯俊明 章容 段光杰 【摘要】 目的 探讨供肝零时相活检病理学改变与术后早期并发症的关系，寻找预示并发症发生的早期形态学指标，为临床采取预防性诊疗措施提供依据。方法 91例肝移植术中零时相活检标本，经常规病理制片，HE染色，利用双盲法进行组织形态学观察。结果 91例供肝有40例(44.0%)发生缺血再灌注损伤。其术后发生排斥反应和胆道并发症的概率及出现晚期或持续性保存损伤的概率显著高于无缺血再灌注损伤表现的供肝(P<0.05)。中央型坏死和细胞凋亡程度较重时排斥反应和胆道并发症发生的概率均显著高于程度较轻的供肝(P<0.05)。汇管区炎症较重的供肝术后出现晚期或持续性保存损伤的概率显著高于汇管区炎症较轻的供肝(P=0.021)。结论 供肝术中灌注后零时相活检的组织病理学改变对术后采取预防性诊疗措施具有重要指导意义。 【关键词】 肝移植； 活检； 再灌注损伤； 并发症； 急性排斥反应 【Abstract】 Objective To investigate relationship between histological features in “timezero” biopsies of donor liver and complications at early stage after liver transplantation, explore early morphological indices predicting complications so as to provide basis for clinical preventive diagnosis and treatment. Methods A total of 91 cases were classified into 5 groups according their complications within six months postoperation,ie, ACR group, bile duct complication group, coincidence of ACR and bile duct complication group, preservation injury group and others. The morphological observation was done on biopsy samples by embedding with paraffin, HE staining and doubleblind method. Results Of all, 40 donor livers (44%) were present with ischemia reperfusion injury. The coincidence of reject reaction and bile duct complication in donor livers with ischemia reperfusion injury were higher than those in donor livers without ischemia reperfusion injury (P<0.05). The coincidence of reject reaction and bile duct complication in livers with severer centralized necrosis and cell apoptosis were higher than those in livers with lighter necrosis and cell apoptosis (P<0.05). The donor livers with severer inflammation in port tract had higher incidence rate of late or persistent preservation injury than those with lighter inflammation in port tract (P<0.05). Conclusion Histological features in “timezero” biopsies play an important role in guiding preventive diagnosis and treatment. 【Key words】 Liver transplantation; Biopsy; Reperfu