肝移植术后常见并发症的病理学特点

目的 探讨肝移植后各种常见并发症的病理学特点.方法 962例肝移植患者共行移植肝穿刺活检1300次,所取肝组织以中性甲醛溶液固定,石蜡包埋,连续切片,常规HE染色,部分病例做Van Gieson染色、Masson 三色染色、网状纤维组织化学染色和免疫组织化学染色,所有组织切片要求在显微镜下可见到3个以上完整的汇管区结构.962例患者的临床及实验室资料完整.结果 1300次活检中,急性排斥反应最为常见,占32.46%,其次为胆道并发症,占25.46%,第3位为药物性肝损伤,占17.15%,其它还有肝炎病毒感染及复发、缺血再灌注损伤、巨细胞病毒感染、慢性排斥反应、肝动脉/门静脉狭窄或梗阻、流出道梗阻、原发病复发、移植肝原发无功能及无病理诊断性异常.其病理学特点,急性排斥反应主要表现为汇管区炎、小叶间胆管损伤和血管炎;胆道并发症表现为汇管区及小叶间胆管周围水肿或纤维化、小叶间胆管损伤和胆汁淤滞;药物性肝损伤表现为Ⅲ带为主的肝细胞水样变性、程度不等的脂肪变性和胆汁淤滞;肝炎病毒感染表现为肝板排列紊乱、肝细胞变性和汇管区单个核细胞浸润;缺血再灌注损伤表现为Ⅲ带为主的肝细胞变性和(或)坏死、胆汁淤滞及汇管区炎;巨细胞病毒感染表现为肝细胞坏死伴中性粒细胞浸润、肝窦及汇管区混合性炎症细胞浸润和轻度胆汁淤滞;慢性排斥反应表现为小叶胆管变性和(或)消失、肝实质纤维化、轻度汇管区和中央静脉炎;肝动脉/门静脉狭窄或梗阻表现为Ⅲ带为主的肝细胞变性及坏死、肝窦轻度扩张、淤血和汇管区轻微炎症;流出道梗阻表现为中央静脉及周围肝窦扩张、淤血,Ⅲ带肝细胞变性、坏死和中央静脉及周围纤维化;移植肝原发无功能表现为肝细胞融合性坏死、肝实质胆汁淤滞和汇管区混合性炎及小胆管增生.结论 肝移植术后各种并发症都存在相对特异的一组病理学特征,但应结合患者的临床表现、治疗方案、肝功能情况及病毒学检测结果等资料,综合分析后作出最终的病理诊断.

The histologic patterns of common complications following liver transplantation

Objective To explore the histological patterns of common complications following liver transplantation.Methods In 1300 cases from 962 liver transplant patients,the percutflneous liver biopsy tissues were stained by HE method.In some of them,Van Gieson,Masson,PAS,reticulin and immunohistochemical staining were performed.At least 3 complete portal areas could be observed in every slide.All the clinical and following data were available.Results Acute cellular rejection(ACR) was the most common complication(32.46%),followed by complication of biliary tract(25.46%)and drug-induced hepatic iniury(17.15%),and other complications included infection or recurrence of hepatitis virus,ischemia-reperfusion injury,CMV infection,chronic rejection,hepatic artery or portal vein stenosis,obstruction of efferent tract,recurrence of the primary affection,non-function of liver grafts.Each complication had its relatively characteristic histological patterns.Conclusion Percutaneons liver biopsy is valuable for the diagnosis of post-transplant complications.Combining with serum and imaging test,it can contribute to the etiological diagnosis and provide the evidence of settling plan of treatment.