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目的探讨肝门部胆管癌的病理学和分子生物学特征。方法分析68例肝门部胆管癌病例的病理学类型、神经和淋巴结浸润发生率;比较不同分化程度组患者血清CA19-9和CEA含量;免疫组织化学法观察肿瘤预后相关基因产物Her-1、Her-2、p170、血管内皮生长因子(VEGF)及突变型p53蛋白;细胞角蛋白CK7、CK18、CK19、CK20;增殖相关蛋白Ki-67、Top-Ⅱ的表达情况。结果68例患者肿瘤病理学类型全部为腺癌,中、低分化腺癌占85.29%;神经浸润发生率为91.18%、淋巴结浸润率为27.94%。高、中、低分化腺癌组,患者血清CA19-9、CEA含量之间的差异无统计学意义(P>0.05)。Her-1、Her-2、p170、VEGF和突变型p53阳性表达率分别为26.1%、21.7%、51.2%、36.0%和48.8%。CK7、CK18、CK19阳性表达率均为100%。Ki-67、Top-Ⅱ阳性率分别为93.3%、83.7%;Kappa检验显示,Ki-67与Top-Ⅱ对胆管癌细胞增殖程度的检验效果一致性较好(P<0.01)。结论肝门部胆管癌以中、低分化腺癌为主;肿瘤具有很高的神经浸润发生率;血清CA19-9、特异性角蛋白检测有助于肝门部胆管癌的鉴别诊断;Ki-67与Top-Ⅱ对肿瘤增值程度的检测效果相当。
Objective To investigate the pathological and molecular biological features of hilar cholangiocarcinoma. Methods The pathological types, the incidence of nerve and lymph node infiltration in 68 cases of hilar cholangiocarcinoma were analyzed. The levels of serum CA19-9 and CEA in patients with different degrees of differentiation were compared. The expression of Her-1, Her-2, p170, vascular endothelial growth factor (VEGF) and mutant p53 protein; cytokeratin CK7, CK18, CK19, CK20; proliferation-related protein Ki-67, Top-Ⅱ expression. Results All 68 patients had adenocarcinoma tumor type, 85.29% had moderate and poorly differentiated adenocarcinoma, 91.18% had nerve infiltration, and 27.94% had lymph node infiltration rate. High, moderate, poorly differentiated adenocarcinoma group, serum CA19-9, CEA content was no significant difference (P> 0.05). The positive rates of Her-1, Her-2, p170, VEGF and mutant p53 were 26.1%, 21.7%, 51.2%, 36.0% and 48.8% respectively. The positive rates of CK7, CK18 and CK19 were all 100%. The positive rates of Ki-67 and Top-Ⅱ were 93.3% and 83.7%, respectively. Kappa test showed that the test results of Ki-67 and Top-Ⅱ on the proliferation of cholangiocarcinoma cells were consistent (P <0.01). Conclusions Hilar cholangiocarcinoma is predominant in moderate and poorly differentiated adenocarcinoma. The tumor has a high incidence of neural invasion. Serum CA19-9 and specific keratin detection contribute to the differential diagnosis of hilar cholangiocarcinoma. Ki- 67 and Top-Ⅱ on the degree of tumor value of the test results.