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目的 探讨不同年龄胆总管囊肿的临床与肝脏纤维化特点与相互关系。方法 分析12例婴儿及36例幼儿、儿童胆总管囊肿的临床资料;肝组织HE染色观察纤维化程度和炎性细胞浸润情况,免疫组化染色观察细胞角化蛋白(AE1/AE3)、人类组织相容性抗原DR(HLA—DR)表达,并与18例胆道闭锁作对照。结果 婴儿胆总管囊肿黄疸出现率12/12,显著高于幼儿儿童组8/36(P<0.01);肝纤维化程度、小叶周边AE1/AE3阳性细胞和HLA—DR在肝脏表达显著高于非婴儿组(P<0.01),低于胆道闭锁组(P<0.01)。肝纤维化程度与黄疸及肝小叶周边AE1/AE3表达分级呈正相关(P<0.05)。结论 婴儿胆总管囊肿以黄疸为主要临床表现,其肝纤维化重于幼儿及儿童组,胆道梗阻和胆小管增生可能是其发生肝纤维化的原因。
Objective To investigate the clinical characteristics and hepatic fibrosis of different age choledochal cysts. Methods The clinical data of 12 cases of infants and 36 cases of children with choledochal cyst were analyzed. The degree of fibrosis and infiltration of inflammatory cells in liver tissue were observed by HE staining. The expression of keratin (AE1 / AE3), human tissue Compatible antigen DR (HLA-DR) expression, and 18 cases of biliary atresia as a control. Results The incidence of jaundice in infants with choledochal cysts was 12/12, significantly higher than that in children and infants (8/36, P <0.01). The degree of liver fibrosis, the expression of AE1 / AE3 positive cells and HLA-DR in the peri-lobect were significantly higher in liver Infant group (P <0.01), lower than biliary atresia group (P <0.01). The degree of liver fibrosis was positively correlated with the expression of AE1 / AE3 in the jaundice and hepatic lobules (P <0.05). Conclusions Infantile cholangiocarcinoma is the main clinical manifestations of jaundice, and its liver fibrosis is heavier in children and children. Biliary obstruction and cholangiole hyperplasia may be responsible for its occurrence of hepatic fibrosis.