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先天性胆道闭锁肝内毛细胆管超微结构与临床预后关系探讨 |
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陈洁 李桂生 刘钧澄 吴义芳
【摘要】 目的 探讨先天性胆道闭锁(CBA)肝脏毛细胆管超微结构与临床预后的关系。方法 用Philips CM10透射电镜观察肝内毛细胆管超微结构,比较肝组织电镜切片中发育良好与发育不良的毛细胆管数目,并与临床预后作比较。结果27例CBA患儿中,肝内毛细胆管发育良好为主13例,其中12例术后生存,生存率为92.31%;毛细胆管发育不良为主的14例中,仅有4例生存,生存率为28.57%,两组生存率有显著性差异(P<0.05)。结论 肝内毛细胆管发育良好为主的CBA患儿术后生存率较发育不良为主的高,肝内毛细胆管的发育情况可作为判断术后临床预后指标之一。 【关键词】 胆道疾病 胆小管 预后
Ultrastructure of Intrahepatic Biliary Canaliculi and Prognosis of Biliary Atre sia.
CHEN Jie, LI Guisheng, LIU Juncheng, et al. Department of Pediatric Surgery, The First Affiliated Hospital, Medical College of Jinan University, Gu angzhou 510630
【Abstract】 Objective To investigate the relationship between the ultrastructure of intrahepatic bilia ry canaliculi and the prognosis of biliary atresia. Methods Transmission electromicroscopy(Philips CM10) was performed on the liver biopsies from 27 patients who were operated on congen ital biliary atresia. The number of well-developed biliary canaliculi was corre lated with the prognosis. Results The survival rates of 13 patients with well-deve loped intrahepatic biliary canaliculi and 14 patients with poorly developed intr a-hepatic biliary canaliculi were92.3%(12/13) and 28.6%(4/14) resp ectively. The difference between the two groups was statistically significant( P<0.05). Conclusion Intra-hepatic biliary canaliculi ultrastructu re could be used as one of the prognostic factors in biliary atresia. 【Key words】 Biliary tract disease Bile canaliculi Prognosis
影响CBA患儿临床预后的因素很多,如发病时间、手术时的年龄、手术者的技术、肝脏的病理情况、胆管炎的发生时间和频率等[1]。如何选择最简便、有效的方法来推测术后临床预后,是许多学者努力的目标。本文采用电子显微镜技术观察肝脏超微结构中毛细胆管发育情况,探讨其与临床预后的关系。
资料与方法 1.临床资料:1994年10月~1998年4月,收入院经手术确诊为CBA患儿27例,行SurugaⅡ手术 13例,Kasai手术12例,肝活检术2例。男性17例,女性10例,年龄30天~11个月。收集术中肝组织标本,用Philips CM10透射电镜检查。 2.方法:电镜切片的制备:①术中获得的肝组织标本立即放入前固定液(2.0%戊二醛和多聚甲醛)固定1~2小时;②标本用PBS缓冲液反复洗涤3次,每次15分钟;③1.0%锇酸固定液固定1小时;④50.0%、70.0%、80.0%、90.0%、95.0%梯度乙醇脱水,再用100%乙醇脱水2次,每次均15分钟,[1] [2] 下一页 上一个医学论文: 先天性胆总管囊肿合并门脉高压症 下一个医学论文: 产前B超诊断和早期手术治疗新生儿消化道畸形和腹壁缺损
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