泡型肝包虫病手术安全切除距离的初步研究  

Preliminary study of reasonable and feasible safe distance for radical resection of hepatic alveolar echinococcosis

作　　者：杨令鹏 邱逸闻 杨先伟[1] 沈舒[1] 王文涛[1] YANG Lingpeng;QIU Yiwen;YANG Xianwei;SHEN Shu;WANG Wentao(Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Hepatobiliary and Pancreatic Surgery,The Second People’s Hospital of Yunnan Province,Kunming 650032,P.R.China)

机构地区：[1]四川大学华西医院肝脏外科,成都610041 [2]云南省第二人民医院肝胆胰外科,昆明650032

出　　处：《中国普外基础与临床杂志》2022年第4期512-516,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探究泡状棘球蚴在肝脏中的浸润范围,从而为泡型肝包虫病(hepatic alveolar echinococcosis,HAE)手术安全切除的距离提供参考。方法前瞻性收集2019年1月至2019年6月期间在四川大学华西医院接受手术治疗的20例HAE患者的术后组织标本。每例患者收集3块同时含有病灶与病灶旁肝组织的交界标本,分为病灶组、0~0.5 cm肝组织组(含0.5 cm)、0.5~1.0 cm肝组织组(含1.0 cm)、1.0~1.5 cm肝组织组(含1.5 cm)和1.5~2.0 cm肝组织组(含2.0 cm)。比较5组肝组织中的Cox1表达量和肝组织的镜下纤维化面积。结果病灶组Cox1的表达量和纤维化面积均高于病灶旁肝组织组(P<0.0001),而各病灶旁肝组织组之间的Cox1表达量和纤维化面积的差异均无统计学意义(P>0.05)。各组的Cox1表达量与镜下纤维化面积均呈正相关关系(P<0.05)。结论无论是Cox1表达量还是肝组织的纤维化程度,HAE病灶均高于病灶旁2 cm以内的肝组织,而病灶旁2 cm以内的肝组织之间并没有明显差异。基于本研究在病灶旁肝组织中间隔0.5 cm的取材标准,笔者认为HAE手术切除的范围在距离病灶0.5 cm处可能较为合适。Objective To explore the reasonable and feasible safe distance for radical resection of hepatic alveolar echinococcosis(HAE).Methods Liver samples were collected prospectively from 20 HAE patients(from Jan.2019 to Jun.2019)undergoing liver resection in West China Hospital of Sichuan University.A total of three samples containing lesion and adjacent liver tissue were collected from each patient,which were divided into lesion group,0 to0.5 cm liver tissue group(contained 0.5 cm),0.5 to 1.0 cm liver tissue group(contained 1.0 cm),1.0 to 1.5 cm liver tissue group(contained 1.5 cm),and 1.5 to 2.0 cm liver tissue group(contained 2.0 cm).Comparisons of the Cox1 expression and the liver fibrosis area between HAE lesion and adjacent liver tissues were performed.Results Both expression of Cox1 and fibrosis area in HAE lesion were significantly higher than those in the adjacent liver tissues(P<0.0001).However,there was no significant difference among the four kinds of adjacent liver tissues(P>0.05).There was a significant positive correlation between the expression of Cox1 and the fibrosis area both in HAE lesion and adjacent liver tissues(P<0.05).Conclusions Both the expression of Cox1 and degree of the liver fibrosis are significant higher in HAE lesion comparing to adjacent liver tissues,however,no significant difference is found among adjacent liver tissues.Consequently,a safe distance of 0.5 cm may be reasonable and feasible on the basis of the criteria for sample collection in the study.

关 键 词：泡型肝包虫病 安全距离 根治性切除 

分 类 号：R657.3[医药卫生—外科学]