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目的分析肝门部胆管癌神经浸润的发生率、方式与规律及影响因素。方法光镜下观察52例肝门部胆管癌患者的484张组织病理切片,分析肿瘤神经浸润的发生率、方式与规律;使用关联分析统计学方法分析神经浸润与淋巴结转移、血清CA19-9水平、血清CEA水平、血清总胆红素水平和肿瘤侵犯胆管壁程度的关系。结果肝门部胆管癌神经浸润总发生率为90.38%(47/52);高、低及未分化腺癌间神经浸润发生率比较差异均无统计学意义(P>0.05)。神经浸润发生率与患者的肿瘤Bismuth-Corlette分型、血清CA19-9水平、血清CEA水平、血清总胆红素水平及淋巴结转移均无关(P>0.05),而与胆管壁浸润程度有关(P<0.01)。肿瘤浸润神经主要有4种方式,其发生率由高至低依次是:Ⅱ型>Ⅲ型>Ⅳ型>Ⅰ型。浸润方式与肿瘤分化程度有关(χ2=31.04,P<0.01)。结论肝门部胆管癌具有神经亲嗜性,神经浸润发生率高;肝门胆管癌神经浸润有多种浸润方式,浸润方式与肿瘤分化程度有关;肿瘤是否浸润神经与淋巴结转移、肿瘤分化程度无关,而与侵犯胆管壁程度有关。
Objective To analyze the incidence, pattern, regularity and influential factors of nerve infiltration in hilar cholangiocarcinoma. Methods 484 histopathological sections of 52 cases of hilar cholangiocarcinoma were observed under light microscope. The incidence, pattern and regularity of tumor neural invasion were analyzed. Correlation analysis was used to analyze the relationship between neural invasion and lymph node metastasis, serum CA19-9 level , Serum CEA level, serum total bilirubin level and the extent of tumor invasion of bile duct. Results The incidence of neural invasion in hilar cholangiocarcinoma was 90.38% (47/52). There was no significant difference in the incidence of nerve infiltration between high, low and undifferentiated adenocarcinoma (P> 0.05). The incidence of neurofilament was not associated with Bismuth-Corlette type, serum CA19-9 level, serum CEA level, serum total bilirubin level and lymph node metastasis (P> 0.05), but not with the degree of infiltration <0.01). Tumor infiltrating nerve mainly in 4 ways, the incidence from high to low are: type Ⅱ> type Ⅲ> type Ⅳ> type Ⅰ. Infiltration and tumor differentiation (χ2 = 31.04, P <0.01). Conclusions The hilar cholangiocarcinoma has neuroendocrinology and high incidence of nerve infiltration. There are many infiltrative modes of infiltration in the hilar cholangiocarcinoma. The infiltration mode is related to the degree of tumor differentiation. Whether the infiltration of the tumor is related to lymph node metastasis or tumor differentiation , But with the extent of violations of the bile duct wall.