单中心209例次移植肝穿刺活检组织病理诊断分析  

Pathological diagnosis of 209 liver transplantation biopsy cases in a single center

作　　者：金美善[1] 李淼[1] 孙丽[1] 曲丽梅[1] Jin Meishan;Li Miao;Sun Li;Qu Limei(Department of Pathology,First Hospital of Jilin University,Changchun 130021,Jilin,China)

机构地区：[1]吉林大学第一医院病理科,吉林长春130021

出　　处：《实用器官移植电子杂志》2023年第5期412-416,共5页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的通过对单中心209例次移植肝穿刺活检组织的病理资料回顾性分析,研究肝移植术后常见并发症的发生情况、病理学改变及鉴别诊断。方法2013年8月至2023年4月在吉林大学第一医院器官移植中心145例患者共行移植肝穿刺活检209次,采用快速石蜡包埋和制片技术流程,常规行HE染色、Masson、D-PAS及网状纤维等组织化学染色和CK7、CMV、C4d等免疫组织化学染色,EBER原位杂交检测EBV感染。结果急性T细胞介导的排斥反应最常见,占36.84%,其次为药物性肝损伤,占23.44%,第3位为胆管并发症,占14.35%,此外还有乙型和丙型肝炎病毒感染或复发、缺血/再灌注损伤、巨细胞病毒感染、慢性排斥反应、富于浆细胞的排斥反应、血管并发症、原发病复发、移植肝原发无功能及难以诊断的肝形态。病理学改变:急性T细胞介导的排斥反应的诊断基于汇管区炎症、胆管上皮的炎性损害及静脉内皮炎,其中58.44%的病例可见经典的汇管区“三联征”,药物性肝损伤最多见的病理改变为Ⅲ带为主的肝细胞变性、脂肪变性、肝细胞及毛细胆管内的胆汁淤积,胆管并发症表现为肝细胞和毛细胆管内胆汁淤积,汇管区内沿着界面分布的小胆管增生,增生胆管周围可见以中性粒细胞为主的炎细胞浸润,间质水肿。结论病理医师需要结合患者的临床表现、实验室检查、影像学资料、用药史等资料综合分析并与临床医师充分沟通讨论后作出病理诊断。Objective The incidence,pathological changes and differential diagnosis of common complications after liver transplantation have been studied,through a retrospective analysis of the pathological data of 209 liver transplant biopsy tissues from a single center.Methods A total of 209 biopsies were performed in 145 patients with liver transplantation from August 2013 to April 2023,at the Organ Transplantation Center of the First Hospital of Jilin University.The liver tissues were fixed with 4%neutral formaldehyde solution,embedded in paraffin and sectioned continuously,routinely HE staining,Masson,D-PAS,reticular fiber histochemical staining,CK7,CMV,C4d immunohistochemical staining and EBER in situ hybridization were performed.Results Acute T cell-mediated rejection(TCMR)was the most common(36.84%)complication,followed by drug-induced liver injury(DILI)(23.44%)and biliary complications(14.35%),others include Hepatitis B and Hepatitis C virus infection or recurrence,ischemia-reperfusion injury,cytomegalovirus infection,chronic rejection,plasma cell-rich rejection,vascular complications,recurrent primary disease,primary graft dysfunction,and difficult-to-diagnose liver morphology.The diagnosis of acute T cell-mediated rejection was based on portal inflammation,bile duct inflammation and venous endothelial inflammation.In 58.44%cases of TCMR,the classic“Triad”of portal area was found.In DILI,there were swelling or ballooning degeneration of hepatocytes around central vein,steatosis with different degrees,cholestasis in hepatocytes and bile canaliculi.Biliary complication was characterized by cholestasis in hepatocytes and bile canaliculi,proliferation of small bile ducts along the interface of the portal tract,and interstitial edema.Conclusion The pathological diagnosis should be made after comprehensive analysis of the clinical manifestation,laboratory examination,imaging data and medication history.

关 键 词：肝移植 穿刺活检组织 病理学 

分 类 号：R657.3[医药卫生—外科学]