【摘要】 目的探讨良性胆管瘢痕性狭窄的形成机制。方法收集14例良性胆管瘢痕性狭窄的胆管瘢痕组织,用10例正常胆管作为对照,分别用光镜、SEM、TEM观察其形态学特点;用免疫组织化学SP法分别检测CD₅₈、TGFβ₁、α-SMA在两组中的表达及定位。结果胆管瘢痕存在以巨噬细胞（MΦ）为主的炎细胞持续浸润,缺血缺氧和MFB等特点。CD₆₈、TGFβ₁、α-SMA在胆管瘢痕中表达较强,与正常胆管有显著差异。CD₆₈主要表达于MΦ。α-SMA表达于MFB的胞浆、血管平滑肌组织、胆管平滑肌。胆管瘢痕中新生血管增多,部分管壁明显增厚。TGFβ₁主要表达于肉芽组织、FB、MΦ等炎细胞。结论胆管瘢痕中存在以MΦ为主的持续慢性炎症,MΦ通过分泌TGFβ₁导致胶原纤维过度沉积、改建不良和MFB的形成,引起胆管瘢痕性狭窄。胆管瘢痕的缺血可能是加剧良性胆管狭窄形成的重要原因。更多还原

【Abstract】 Objective To explore the mechanism of the benign biliary stricture.Methods The samples of biliary scars were collected from 14 patients with the benign biliary stricture and 10 cases of normal biliary tissues were collected.The microstructure and ultrastructure of tissues in both groups were studied with light microscopy and scanning electron microscopy and transmission electron micros- copy,respective.Expression and location of CD₆₈,TGFβ₁,α-SMA were studied with immunohisto- chemical SP staining.Results The hiliary scars featured with the lasting existence of chronic inflam- mation with infiltration of macrophage,poor local blood supply and existence of myofibroblast.The expression of CD₆₈,TGFβ1,α-SMA in biliary scars was significantly different from that in normal bile duct using immunohistochemical method.CD₆₈was mainly found in macrophage,α-SMA in myofibro- blast,smooth muscle of blood vessel and bile duct,TGFβ1 in granulation tissues,fibroblasts,and massive inflammatory cells such as neutrophil,lymphocyte.In the biliary scars,the number of neoge- netic vessel increased and part of the wall was significantly thickened.Conclusion Continuous infiltra- tion of macrophage in bile duct wall is a major cause of formation of the benign biliary stricture.Mac- rophage can promote the transformation of myofibroblast and overdisposition of collageous fiber through excretion of TGFβ1.Ischemia and anoxia in biliary scars maybe strengthen formation of the biliary scars.更多还原