囊型肝包虫病合并胆瘘对其生命周期影响的研究
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摘要
目的：研究胆瘘对囊型肝包虫病的影响,探讨囊型肝包虫病自然生长、衰老、身亡的过程。
方法：动物实验研究,40只小鼠随即分为实验组和对照组,实验组腹腔接种经胆汁处理20分钟后的原头蚴,对照组接种生理盐水处理的原头蚴,3月后按囊湿重、常规病理切片进行评价；临床病例研究,回顾性调查402例囊型肝包虫病患者共有509个包虫囊的B超影像进行分类、囊肿大小,手术切除包虫囊肿后观察胆瘘发生情况,探讨包虫分型及活性和胆瘘发生率、包虫囊肿大小的关系。
结果：动物研究显示：实验组和对照组囊湿重分别为11.94±6.56mmg,23.06±3.02mg, (P<0.01),囊肿病理损害程度无差异(P>0.05)。临床研究显示：Ⅰ型包虫胆瘘发生率为5.2%,Ⅱ型包虫胆瘘发生率为36.6%,Ⅲ型包虫胆瘘发生率为72.0%,Ⅳ型包虫胆瘘发生率为87.1%,Ⅴ型包虫胆瘘发生率为90.9%。CL型和Ⅰ型包虫胆瘘发生率差异无统计学意义(P>0.05)；Ⅰ型和Ⅱ型包虫胆瘘发生率差异有统计学意义(P<0.05)；Ⅱ型和Ⅲ型包虫胆瘘发生率差异有统计学意义(P<0.05)；Ⅲ型、Ⅳ型和Ⅴ型之间比较差异无统计学意义(P>0.05)。活包虫组胆瘘发生率为24.4%,过度期包虫组胆瘘发生率72.0%,死包虫组胆瘘发生率88.1%,活包虫组和过渡期包虫比较差异有统计学意义(P<0.001),过渡期组和死包虫组比较差异无统计学意义。发生胆瘘包虫囊肿平均直径9.88±4.29cm,未发生胆瘘包虫囊肿平均直径9.25±3.60cm,二者比较差异无统计学意义,CL型包虫囊肿平均直径11.20±1.93cm,Ⅰ型包虫囊肿平均直径9.33±3.48 cm,Ⅱ型包虫囊肿平均直径9.85±4.83cm,Ⅲ型包虫囊肿平均直径9.45±3.91cm,Ⅳ型包虫囊肿平均直径7.53±3.79cm,V型包虫囊肿平均直径5.64±1.91cm,CL型、Ⅰ型、Ⅱ型、Ⅲ型囊肿大小比较差异无统计学意义,Ⅳ型与V型囊肿大小比较差异无统计学差异,而CL型、Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型、Ⅴ型囊肿大小比较差异有统计学意义。
结论：在动物实验中胆汁短时间内不能直接杀灭包虫原头蚴,但是可以抑制包虫的囊肿生长。在临床研究中显示包虫囊肿大小与胆瘘发生无关,但随着包虫向衰老、死亡自然演变,包虫体积逐渐缩小,胆瘘发生率逐渐增加,胆瘘是导致包虫死亡的重要原因。
Objective:To study the effects of biliary fistula on life period of Hepatic Cystic Echinococcosis (C.E.), in order to explore the process of growing, getting old and dying of C.E.
Methods:In the animal experiment, mice were divided into experimental group and control group. Mice in experimental group and control group were inoculated with protoscoleces, which was soaked in the human bile and in the normal saline for 20 minutes respectively. Three months later, cyst wet weight and cyst pathological changes were assessed. In the clinical case study, retrospective analysis was carried on 509 cysts of 402 cases for typing under B ultrasound, size and postoperative biliary fistula, in order to explore the relationship between cyst type and biliary fistula rate, cyst size.
Result:In the animal study, cyst wet weight of experimental group and control group was 11.94±6.56mg, 23.06±3.02mg,respectively, the variability had statistical significance (P<0.01). The pathological changes of two groups had no significant difference (P>0.05). In the clinical case study, biliary fistula rate of type CL, typeⅠ, typeⅡ, typeⅢ, typeⅣand typeⅤwas 0%,5.2%,36.6%,72.0%,87.1%,90.9% respectively. The variability had statistical significance between type I and type II, (P<0.05)The variability had no statistical significance between type CL and typeⅠ, typeⅡand typeⅢ, typeⅣand typeⅤ, (P>0.05). The biliary fistula rate of live cyst, transitional cyst and was 24.4%,72.0% and 88.1%. The variability had statistical significance between live cyst and, (P<0.05).The variability had no statistical significance between transitional cyst and dead cyst, The mean diameter of the cyst with and without fistula was 9.88±4.29cm and 9.25±3.60cm, between which there was no significant difference. The mean diameter of type CL, typeⅠ, typeⅡ, typeⅢ, typeⅣand typeⅤwas 11.20±1.93cm,9.33±3.48 cm,9.85±4.83cm, 9.45±3.91cm,7.53±3.79cm and 5.64±1.91cm respectively. The variability among type CL, typeⅠ,typeⅡ,typeⅢand between typeⅣand typeⅤhad no statistical significance. The size variability of type CL, typeⅠ,typeⅡ,typeⅢand typeⅣ, typeⅤhad statistical significance.
Conclusion:In the time of 20 minutes, bile can not inactive the protoscoleces, however, it can resist the growth of the cyst. The clinical study shows no relationship between cyst diameter and biliary fistula rate. As the cyst getting old and dying, the cyst decreased in size and increased in biliary fistula rate. The biliary fistula is one important reason for death of cyst.
方法：动物实验研究,40只小鼠随即分为实验组和对照组,实验组腹腔接种经胆汁处理20分钟后的原头蚴,对照组接种生理盐水处理的原头蚴,3月后按囊湿重、常规病理切片进行评价；临床病例研究,回顾性调查402例囊型肝包虫病患者共有509个包虫囊的B超影像进行分类、囊肿大小,手术切除包虫囊肿后观察胆瘘发生情况,探讨包虫分型及活性和胆瘘发生率、包虫囊肿大小的关系。
结果：动物研究显示：实验组和对照组囊湿重分别为11.94±6.56mmg,23.06±3.02mg, (P<0.01),囊肿病理损害程度无差异(P>0.05)。临床研究显示：Ⅰ型包虫胆瘘发生率为5.2%,Ⅱ型包虫胆瘘发生率为36.6%,Ⅲ型包虫胆瘘发生率为72.0%,Ⅳ型包虫胆瘘发生率为87.1%,Ⅴ型包虫胆瘘发生率为90.9%。CL型和Ⅰ型包虫胆瘘发生率差异无统计学意义(P>0.05)；Ⅰ型和Ⅱ型包虫胆瘘发生率差异有统计学意义(P<0.05)；Ⅱ型和Ⅲ型包虫胆瘘发生率差异有统计学意义(P<0.05)；Ⅲ型、Ⅳ型和Ⅴ型之间比较差异无统计学意义(P>0.05)。活包虫组胆瘘发生率为24.4%,过度期包虫组胆瘘发生率72.0%,死包虫组胆瘘发生率88.1%,活包虫组和过渡期包虫比较差异有统计学意义(P<0.001),过渡期组和死包虫组比较差异无统计学意义。发生胆瘘包虫囊肿平均直径9.88±4.29cm,未发生胆瘘包虫囊肿平均直径9.25±3.60cm,二者比较差异无统计学意义,CL型包虫囊肿平均直径11.20±1.93cm,Ⅰ型包虫囊肿平均直径9.33±3.48 cm,Ⅱ型包虫囊肿平均直径9.85±4.83cm,Ⅲ型包虫囊肿平均直径9.45±3.91cm,Ⅳ型包虫囊肿平均直径7.53±3.79cm,V型包虫囊肿平均直径5.64±1.91cm,CL型、Ⅰ型、Ⅱ型、Ⅲ型囊肿大小比较差异无统计学意义,Ⅳ型与V型囊肿大小比较差异无统计学差异,而CL型、Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型、Ⅴ型囊肿大小比较差异有统计学意义。
结论：在动物实验中胆汁短时间内不能直接杀灭包虫原头蚴,但是可以抑制包虫的囊肿生长。在临床研究中显示包虫囊肿大小与胆瘘发生无关,但随着包虫向衰老、死亡自然演变,包虫体积逐渐缩小,胆瘘发生率逐渐增加,胆瘘是导致包虫死亡的重要原因。
Objective:To study the effects of biliary fistula on life period of Hepatic Cystic Echinococcosis (C.E.), in order to explore the process of growing, getting old and dying of C.E.
Methods:In the animal experiment, mice were divided into experimental group and control group. Mice in experimental group and control group were inoculated with protoscoleces, which was soaked in the human bile and in the normal saline for 20 minutes respectively. Three months later, cyst wet weight and cyst pathological changes were assessed. In the clinical case study, retrospective analysis was carried on 509 cysts of 402 cases for typing under B ultrasound, size and postoperative biliary fistula, in order to explore the relationship between cyst type and biliary fistula rate, cyst size.
Result:In the animal study, cyst wet weight of experimental group and control group was 11.94±6.56mg, 23.06±3.02mg,respectively, the variability had statistical significance (P<0.01). The pathological changes of two groups had no significant difference (P>0.05). In the clinical case study, biliary fistula rate of type CL, typeⅠ, typeⅡ, typeⅢ, typeⅣand typeⅤwas 0%,5.2%,36.6%,72.0%,87.1%,90.9% respectively. The variability had statistical significance between type I and type II, (P<0.05)The variability had no statistical significance between type CL and typeⅠ, typeⅡand typeⅢ, typeⅣand typeⅤ, (P>0.05). The biliary fistula rate of live cyst, transitional cyst and was 24.4%,72.0% and 88.1%. The variability had statistical significance between live cyst and, (P<0.05).The variability had no statistical significance between transitional cyst and dead cyst, The mean diameter of the cyst with and without fistula was 9.88±4.29cm and 9.25±3.60cm, between which there was no significant difference. The mean diameter of type CL, typeⅠ, typeⅡ, typeⅢ, typeⅣand typeⅤwas 11.20±1.93cm,9.33±3.48 cm,9.85±4.83cm, 9.45±3.91cm,7.53±3.79cm and 5.64±1.91cm respectively. The variability among type CL, typeⅠ,typeⅡ,typeⅢand between typeⅣand typeⅤhad no statistical significance. The size variability of type CL, typeⅠ,typeⅡ,typeⅢand typeⅣ, typeⅤhad statistical significance.
Conclusion:In the time of 20 minutes, bile can not inactive the protoscoleces, however, it can resist the growth of the cyst. The clinical study shows no relationship between cyst diameter and biliary fistula rate. As the cyst getting old and dying, the cyst decreased in size and increased in biliary fistula rate. The biliary fistula is one important reason for death of cyst.
引文
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[2]Yang YR, Sun T, Li Z, et al. Community surveys and risk factor analysis of human alveolar and cystic echinococcosis in Ningxia Hui Autonomous Region, China [J]. Bull World Health Organ.2006,84(10):840.
[3]Pak soyM, Karahasanoglu hydatid disease of the liver into the biliary tracts [J]. D ig Surg,1998,15 (10):25-29.
[4]ZaoucheA, Haouet K, JouiniM, et al. Management of liver hydatid cysts w ith a large biliocystic fistula:multicenter retrospective study[J]. World J Surg,2001,25 (11):28-39.
[5]杨宏强,彭心宇,张示杰,等.肝细粒棘球蚴病合并胆瘘的手术治疗-附203例分析[J].中国现代医学杂志,2006,16(15)：2319-2322.
[6]彭心宇,张示杰,牛建华,等.肝包虫外膜内完整摘除术.中华普通外科[J].2002,17：529—530.
[7].彭心宇,肝包虫病的外科治疗新观点.中国实用外科杂志[J].2003,23：651—653.
[8]杨宏强,彭心宇,牛建华,等.囊型肝包虫病合并胆瘘的临床分型初探[J].中国现代医学杂志,2006,16(5)：728-730.
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