肝包虫囊肿周围纤维囊壁病理结构的再认识
彭心宇,吴向未, 张示杰, 牛建华, 石河子大学医学院第一附属医院普外一科,新疆地方与民族高发性疾病省部共建教育部重点实验室
新疆维吾尔族自治区 832008
国家自然科学基金资助项目,No. 30260108
新疆生产建设兵团科研攻关课题,No. NKB01SDXNK30YX
彭心宇, 男, 1959-01-06生, 湖南省祁东县人,汉族.1989年武汉同济医科大学外科学硕士毕业,教授.主要从事普通外科,专于肝胆胰疾病临床研究.
项目负责人: 彭心宇, 832008, 新疆维吾尔族自治区,石河子大学医学院第一附属医院普外一科. pengxy2000@yahoo.com
, http://www.100md.com
电话:0993-2859449 传真: 0993-2859443
收稿日期:2005-01-10 接受日期: 2005-01-20
摘要肝包虫病又称肝棘球蚴病，是畜牧地区的地方性流行性寄生虫病.肝包虫病有两种类型，一种是细粒棘球蚴引起的细粒棘球蚴病，亦称肝囊性包虫病;另一种是泡状棘球蚴感染所致的泡状棘球蚴病，前者多见.目前药物治疗肝囊性包虫病尚不确切，确诊后需手术治疗.在外科实践中发现，肝包虫囊肿周围纤维性囊壁中，肝包虫外囊与肝实质间还存在着一层新的膜样纤维结构，外囊与此膜之间有一新的潜在可分离间隙，沿此间隙可完整摘除包虫囊肿及外囊，这是传统理论所不能解释的.通过病理组织学、免疫组织化学及分子生物学等技术，证实了这层新的膜样纤维结构的存在，并初步对肝包虫囊肿周围纤维囊壁病理结构形成机制提出了新的认识.
, 百拇医药 关键词:肝色虫病;囊肿; 纤维囊壁
彭心宇,吴向未, 张示杰,牛建华.肝包虫囊肿周围纤维囊壁病理结构的再认识.世界华人消化杂志 2005;13(3):276-279
Al Karawi MA, El-Shickh Mohamed AR, Yasawi ML. Advance in diagnosisand management of hydatid disease.
Hepatogastroenterology 1990;37:327-331
2 Gil-Grande LA, Boixeda D, Garcia-Hoz F, Barcena R, Lledo A, SuarezE, Pascasio JM, Moreira V. Treatment of liver hydatid
, http://www.100md.com
disease with mebendazole:a prospectivestudy of thirteen cases. Am J Gastroenterol 1983;78:584-588
3 Morris DL. Pre-operative albendazole therapy for hydatid cyst. BrJ Surg 1987;74:805-806
4 徐明谦.1314例肝包虫病临床分析. 中国寄生虫学与寄生虫病杂志 1993;11:215-218
5 Uhl W, Loffler H, Zimmermann A, Tcholakov O, Gloor B, Buchler MW.Surgical treatment of echinococcosis of the liver.
, 百拇医药 Swiss Surgry 1999;5:126-132
6 Akin ML, Erenoglu C, Uncu EU, Basekim C, Batkin A. Surgicalmanagement of hydatid disease of the liver:a military
experience. J R Army Med Corps 1998;144:139-143
7 Safioleas M, Misiakos E, Manti C, Katsikas D, Skalkeas G.Diagnostic evaluation and surgical management of hydatid
disease of the liver. World J Surg 1994;18:859-865
, http://www.100md.com
8 Demirci S, Eraslan S, Anadol E, Bozatli L. Comparison of results ofdifferent surgical techniques in the management
of hydatid cysts of the liver. World JSurg 1989;13:88-90
9 Nazyrov FG, Vakhidov AV, Ilkhamov FA, Abdurakhmanov BA. Thesurgical treatment of echinococcosis of the
diaphragmatic surface of the liver. Khirurgiia 1999;6:35-37
10 Gonzalez EM,Meneu-Diaz JC, Moreno-Elola A. Echinococcal Cysts: Personal approach tothe surgical treatment
, http://www.100md.com
of echinococcal cysts. In: BakerRJ, Fischer JE. Mastery of surgery. 4th ed. Philadelphia:Lippincott
Williams Wilkins Inc 2001:1100-1107
11 Cangiotti L, Giulini SM, Muiesan P, Nodari F, Begni A, Tiberio G.Hydatid disease of the liver:long term results of
surgical treatment. G Chir 1991;12:501-504
12 Alfieri S, Doglietto GB, Pacelli F, Costamagna G, Carriero C,Mutignani M, Liberatori M, Crucitti F. Radical surgery for liver
, 百拇医药
hydatid disease:a study of 89consecutive patients. Hepatogastroenterology 1997;44:496-500
13 Prousalidis J, Tzardinoglou E, Kosmidis C, Katsohis K, Aletras O.Surgical management of calcified hydatid cysts of
the liver. HPB Surg 1999;11:253-259
14 彭心宇, 张示杰, 牛建华, 吴向未,潘惠忠, 莫拉提,陈裕, 杨宏强. 肝包虫外膜内完整摘除术.
中华普通外科杂志 2002;17:529-530
, http://www.100md.com 15 吴少廷. 包虫病. 梁扩寰. 肝脏病学.第1版. 北京人民卫生出版社, 1995:870-876
16 Saidi F.Echinococcal cysts:etiology, diagnosis, complications, and medical andsurgical treatment. In:Baker RJ,Fischer JE. Mastery of surgery. 4thed. Philadelphia:Lippincott Williams Wilkins Inc 2001:1082-1099
17 顾树南, 黄志强. 肝包虫囊肿手术.腹部外科手术学. 第1版.长沙:湖南科学技术出版社, 2001:639-649
18 Milicevic MN.Hydatid disease. In:L. H. Blumgart. Surgery of the Liver and BiliaryTract. 3rd ed.
, 百拇医药
Health Science Asia, ElservierScience 2001:1167-1204
19 王要军, 孙自勤. 肝窦内皮细胞与纤维化.临床肝胆病杂志 1996;12:115
20 Ryhanen L, Stenback F, Ala-Kokko L, Savolainen ER. The effect ofmalotilate on type III and type IV collagen IV,laminin and fibronectin metabolismin dimethylnitrosamine-induced liver fibrosis in the rat.
J Hepatol 1996;24:238-245
21 Nakayama Y, Takahara T, Miyabayashi CR, Itoh H, Watanabe A, SasakiH, Muragaki Y, Ooshima A, Inoue K.
, http://www.100md.com
Ultrastructural localization oftype IV collagen IV and laminin in the Disse space of rat liver withcarbon
tetrachloride induced fibrosis. Liver 1991;11:260-271
22 Murawaki Y, Ikuta Y, Koda M, Yamada S, Kawasaki H. Comparison ofserum 7S fragment of type IV collagen IV
and serum central triple-helix oftype IV collagen IV for assessment of liver fibrosis in patients withchronic viral
, 百拇医药
liver disease. J Hepatol 1996;24:148-154
23 Tsutsumi M, Takase S, Urashima S, Ueshima Y, Kawahara H, Takada A.Serum markers for hepatic fibrosis in
alcoholic liver disease:which isthe best marker, type III procollagen IV, type IV collagen IV, laminin,tissue inhibitor
of metalloproteinase, or prolylhydroxylase? Alcohol Clin Exp Res 1996;20:1512-1517
24 Simon K, Zalewska M, Gladysz A, Rotter K, Piszko P, Glowacki A.Plasma fibronectin in chronic liver disease-marker
, 百拇医药
of fibrosis? Przegl Lek 1995;52:129-132
25 Yamauchi M, Nakajima H, Ohata M, Hirakawa J, Mizuhara Y, NakaharaM, Kimura K, Fujisawa K, Kameda H. Detection
of fibronectin receptor in sera:Itsclinical significance as a parametar of hepatic fibrosis. Hepatology 1991;14:244
26 Lebensztejn DM, Sobaniec-Lotowska M, Kaczmarski M, Werpachowska I,Sienkiewicz J. Serum concentration of
, 百拇医药
transforming growth factor(TGF)-beta1 does not predict advanced liver fibrosis in children with chronichepatitis B.
Hepatogastroenterology 2004;51:229-233
27 Akahoshi T, Hashizume M, Tanoue K, Shimabukuro R, Gotoh N, TomikawaM, Sugimachi K. Role of the spleen in
liver fibrosis in rats may bemediated by transforming growth factor beta-1. J Gastroenterol Hepatol 2002;17:59-65
, 百拇医药
28 Nakamura T, Sakata R, Ueno T, Sata M, Ueno H. Inhibition oftransforming growth factor beta prevents progression
of liver fibrosis and enhanceshepatocyte regeneration in dimethylnitrosamine-treated rats.
Hepatology 2000;32:247-255
29 Rieder H, Armbrust T, Meyer zum Buschenfelde KH, Ramadori G.Contribution of sinusoidal endothelial liver cells to
liver fibrosis:expression oftransforming growth factor-beta 1 receptors and modulation of plasmin-generatingenzymes
, 百拇医药
by transforming growth factor-beta1. Hepatology 1993;18:937-944
30 Qi Z, Atsuchi N, Ooshima A, Takeshita A, Ueno H. Blockade of typebeta transforming growth factor signaling prevents
liver fibrosis and dysfunction inthe rat. Proc Natl Acad Sci USA 1999;96:2345-2349
31 Okuno M, Moriwaki H, Imai S, Muto Y, Kawada N, Suzuki Y, Kojima S.Retinoids exacerbate rat liver fibrosis by inducing
, 百拇医药
the activation of latent TGF-bin liver stellate cells. Hepatology 1997;26:913
32 Annoni G, Weiner FR, Zern MA. Increased transforming growthfactor-beta 1 gene expression in human liver disease.
J Hepatol 1992;14:259-264
33 贾继东, 王惠吉, 漆德芳. 肝纤维化.肝硬化. 第1版.北京:北京科学技术出版社, 2000:85-112
34 Itamura K, Nakamoto Y, Akiyama M, Fujii C, Kondo T, Kobayashi K,Kaneko S, Mukaida N. Pathogenic roles of tumor
necrosis factorreceptor p55-mediated signals in dimethylnitrosamine-induced murine liverfibrosis.
Lab Invest 2002;82:571-583
编辑 张海宁, http://www.100md.com
新疆维吾尔族自治区 832008
国家自然科学基金资助项目,No. 30260108
新疆生产建设兵团科研攻关课题,No. NKB01SDXNK30YX
彭心宇, 男, 1959-01-06生, 湖南省祁东县人,汉族.1989年武汉同济医科大学外科学硕士毕业,教授.主要从事普通外科,专于肝胆胰疾病临床研究.
项目负责人: 彭心宇, 832008, 新疆维吾尔族自治区,石河子大学医学院第一附属医院普外一科. pengxy2000@yahoo.com
, http://www.100md.com
电话:0993-2859449 传真: 0993-2859443
收稿日期:2005-01-10 接受日期: 2005-01-20
摘要肝包虫病又称肝棘球蚴病，是畜牧地区的地方性流行性寄生虫病.肝包虫病有两种类型，一种是细粒棘球蚴引起的细粒棘球蚴病，亦称肝囊性包虫病;另一种是泡状棘球蚴感染所致的泡状棘球蚴病，前者多见.目前药物治疗肝囊性包虫病尚不确切，确诊后需手术治疗.在外科实践中发现，肝包虫囊肿周围纤维性囊壁中，肝包虫外囊与肝实质间还存在着一层新的膜样纤维结构，外囊与此膜之间有一新的潜在可分离间隙，沿此间隙可完整摘除包虫囊肿及外囊，这是传统理论所不能解释的.通过病理组织学、免疫组织化学及分子生物学等技术，证实了这层新的膜样纤维结构的存在，并初步对肝包虫囊肿周围纤维囊壁病理结构形成机制提出了新的认识.
, 百拇医药 关键词:肝色虫病;囊肿; 纤维囊壁
彭心宇,吴向未, 张示杰,牛建华.肝包虫囊肿周围纤维囊壁病理结构的再认识.世界华人消化杂志 2005;13(3):276-279
Al Karawi MA, El-Shickh Mohamed AR, Yasawi ML. Advance in diagnosisand management of hydatid disease.
Hepatogastroenterology 1990;37:327-331
2 Gil-Grande LA, Boixeda D, Garcia-Hoz F, Barcena R, Lledo A, SuarezE, Pascasio JM, Moreira V. Treatment of liver hydatid
, http://www.100md.com
disease with mebendazole:a prospectivestudy of thirteen cases. Am J Gastroenterol 1983;78:584-588
3 Morris DL. Pre-operative albendazole therapy for hydatid cyst. BrJ Surg 1987;74:805-806
4 徐明谦.1314例肝包虫病临床分析. 中国寄生虫学与寄生虫病杂志 1993;11:215-218
5 Uhl W, Loffler H, Zimmermann A, Tcholakov O, Gloor B, Buchler MW.Surgical treatment of echinococcosis of the liver.
, 百拇医药 Swiss Surgry 1999;5:126-132
6 Akin ML, Erenoglu C, Uncu EU, Basekim C, Batkin A. Surgicalmanagement of hydatid disease of the liver:a military
experience. J R Army Med Corps 1998;144:139-143
7 Safioleas M, Misiakos E, Manti C, Katsikas D, Skalkeas G.Diagnostic evaluation and surgical management of hydatid
disease of the liver. World J Surg 1994;18:859-865
, http://www.100md.com
8 Demirci S, Eraslan S, Anadol E, Bozatli L. Comparison of results ofdifferent surgical techniques in the management
of hydatid cysts of the liver. World JSurg 1989;13:88-90
9 Nazyrov FG, Vakhidov AV, Ilkhamov FA, Abdurakhmanov BA. Thesurgical treatment of echinococcosis of the
diaphragmatic surface of the liver. Khirurgiia 1999;6:35-37
10 Gonzalez EM,Meneu-Diaz JC, Moreno-Elola A. Echinococcal Cysts: Personal approach tothe surgical treatment
, http://www.100md.com
of echinococcal cysts. In: BakerRJ, Fischer JE. Mastery of surgery. 4th ed. Philadelphia:Lippincott
Williams Wilkins Inc 2001:1100-1107
11 Cangiotti L, Giulini SM, Muiesan P, Nodari F, Begni A, Tiberio G.Hydatid disease of the liver:long term results of
surgical treatment. G Chir 1991;12:501-504
12 Alfieri S, Doglietto GB, Pacelli F, Costamagna G, Carriero C,Mutignani M, Liberatori M, Crucitti F. Radical surgery for liver
, 百拇医药
hydatid disease:a study of 89consecutive patients. Hepatogastroenterology 1997;44:496-500
13 Prousalidis J, Tzardinoglou E, Kosmidis C, Katsohis K, Aletras O.Surgical management of calcified hydatid cysts of
the liver. HPB Surg 1999;11:253-259
14 彭心宇, 张示杰, 牛建华, 吴向未,潘惠忠, 莫拉提,陈裕, 杨宏强. 肝包虫外膜内完整摘除术.
中华普通外科杂志 2002;17:529-530
, http://www.100md.com 15 吴少廷. 包虫病. 梁扩寰. 肝脏病学.第1版. 北京人民卫生出版社, 1995:870-876
16 Saidi F.Echinococcal cysts:etiology, diagnosis, complications, and medical andsurgical treatment. In:Baker RJ,Fischer JE. Mastery of surgery. 4thed. Philadelphia:Lippincott Williams Wilkins Inc 2001:1082-1099
17 顾树南, 黄志强. 肝包虫囊肿手术.腹部外科手术学. 第1版.长沙:湖南科学技术出版社, 2001:639-649
18 Milicevic MN.Hydatid disease. In:L. H. Blumgart. Surgery of the Liver and BiliaryTract. 3rd ed.
, 百拇医药
Health Science Asia, ElservierScience 2001:1167-1204
19 王要军, 孙自勤. 肝窦内皮细胞与纤维化.临床肝胆病杂志 1996;12:115
20 Ryhanen L, Stenback F, Ala-Kokko L, Savolainen ER. The effect ofmalotilate on type III and type IV collagen IV,laminin and fibronectin metabolismin dimethylnitrosamine-induced liver fibrosis in the rat.
J Hepatol 1996;24:238-245
21 Nakayama Y, Takahara T, Miyabayashi CR, Itoh H, Watanabe A, SasakiH, Muragaki Y, Ooshima A, Inoue K.
, http://www.100md.com
Ultrastructural localization oftype IV collagen IV and laminin in the Disse space of rat liver withcarbon
tetrachloride induced fibrosis. Liver 1991;11:260-271
22 Murawaki Y, Ikuta Y, Koda M, Yamada S, Kawasaki H. Comparison ofserum 7S fragment of type IV collagen IV
and serum central triple-helix oftype IV collagen IV for assessment of liver fibrosis in patients withchronic viral
, 百拇医药
liver disease. J Hepatol 1996;24:148-154
23 Tsutsumi M, Takase S, Urashima S, Ueshima Y, Kawahara H, Takada A.Serum markers for hepatic fibrosis in
alcoholic liver disease:which isthe best marker, type III procollagen IV, type IV collagen IV, laminin,tissue inhibitor
of metalloproteinase, or prolylhydroxylase? Alcohol Clin Exp Res 1996;20:1512-1517
24 Simon K, Zalewska M, Gladysz A, Rotter K, Piszko P, Glowacki A.Plasma fibronectin in chronic liver disease-marker
, 百拇医药
of fibrosis? Przegl Lek 1995;52:129-132
25 Yamauchi M, Nakajima H, Ohata M, Hirakawa J, Mizuhara Y, NakaharaM, Kimura K, Fujisawa K, Kameda H. Detection
of fibronectin receptor in sera:Itsclinical significance as a parametar of hepatic fibrosis. Hepatology 1991;14:244
26 Lebensztejn DM, Sobaniec-Lotowska M, Kaczmarski M, Werpachowska I,Sienkiewicz J. Serum concentration of
, 百拇医药
transforming growth factor(TGF)-beta1 does not predict advanced liver fibrosis in children with chronichepatitis B.
Hepatogastroenterology 2004;51:229-233
27 Akahoshi T, Hashizume M, Tanoue K, Shimabukuro R, Gotoh N, TomikawaM, Sugimachi K. Role of the spleen in
liver fibrosis in rats may bemediated by transforming growth factor beta-1. J Gastroenterol Hepatol 2002;17:59-65
, 百拇医药
28 Nakamura T, Sakata R, Ueno T, Sata M, Ueno H. Inhibition oftransforming growth factor beta prevents progression
of liver fibrosis and enhanceshepatocyte regeneration in dimethylnitrosamine-treated rats.
Hepatology 2000;32:247-255
29 Rieder H, Armbrust T, Meyer zum Buschenfelde KH, Ramadori G.Contribution of sinusoidal endothelial liver cells to
liver fibrosis:expression oftransforming growth factor-beta 1 receptors and modulation of plasmin-generatingenzymes
, 百拇医药
by transforming growth factor-beta1. Hepatology 1993;18:937-944
30 Qi Z, Atsuchi N, Ooshima A, Takeshita A, Ueno H. Blockade of typebeta transforming growth factor signaling prevents
liver fibrosis and dysfunction inthe rat. Proc Natl Acad Sci USA 1999;96:2345-2349
31 Okuno M, Moriwaki H, Imai S, Muto Y, Kawada N, Suzuki Y, Kojima S.Retinoids exacerbate rat liver fibrosis by inducing
, 百拇医药
the activation of latent TGF-bin liver stellate cells. Hepatology 1997;26:913
32 Annoni G, Weiner FR, Zern MA. Increased transforming growthfactor-beta 1 gene expression in human liver disease.
J Hepatol 1992;14:259-264
33 贾继东, 王惠吉, 漆德芳. 肝纤维化.肝硬化. 第1版.北京:北京科学技术出版社, 2000:85-112
34 Itamura K, Nakamoto Y, Akiyama M, Fujii C, Kondo T, Kobayashi K,Kaneko S, Mukaida N. Pathogenic roles of tumor
necrosis factorreceptor p55-mediated signals in dimethylnitrosamine-induced murine liverfibrosis.
Lab Invest 2002;82:571-583
编辑 张海宁, http://www.100md.com
