• 作者： 柯成國
• 作者服務機構： 高雄醫學院外科
• 中文摘要： 肝內結石症及膽管癌之關連是一直被認為有關的，在肝內結石症之膽管表皮細胞增生變化是常見的。本研究是將肝內結石症（21例）、肝內結石症合併膽管癌（14例）及肝內結石切除標本無膽石膽管（11例）做為對照組，各組標本染出細胞核仁區來計算核仁數且以判定其增生程度。核仁區可分成點狀型及結合型二種。點狀型計算數目，但結合型計算含此型之百分比。在肝內結石病例：膽管內腺體及膽管外腺體之核仁數分別為2.7 ± 1.2 (M ± SD)及3.6± ±.2，而膽管癌細胞數目為4.7±2.4之明顯增加，而且結合型占有28.1±4.4％，遠高於膽管表皮而與膽管外腺體相近。因此經這研究我們認為增生癌化因素可能源由膽管表皮或膽管內腺體產生，而膽管表皮及膽管內腺體雖易接觸感染性膽汁及膽石之物理性刺激，但較易脫落，所以實際癌化之病巢可能在膽管外腺體群，因其核仁變化與癌細胞群相近。結論，肝內結石會形成膽管癌可能性相當可信，尤其是膽管外腺體群，因此在治療上必須更加注意。
• 英文摘要： Hepatolithiasis and bile duct cancer have usually been linked together especially in Asian countries.Epithelium cells of bile duct or ductal glands had proliferative changes in patients with hepatolithiasisusually. The numbers and shape of the nucleoli were studied with special staining of AgNOR (NucleolarOrganizer Regions) on bile ducts without calculi (n = 11), with calculi (n = 21), and hepatolithiasis with bileduct carcinoma (n = 14). The patterns of AgNOR were classified into a dotted type and a cluster type underlight microscopic examination. AgNORs scores were found to be 2.7 ± 1.2 (M ± SD) and 3.6 ± 1.2 forintramural glandular cells and extramural glandular cells in hepatolithiasis (p < 0.05). In the cases of bileduct carcinoma, the percentage of the cluster form of AgNOR was 28.1 ± 4.4%, and the scores were 4.7 ± 2.4for bile duct cancer, which was significantly different from intramural glands, but not different from theextramural glands in hepatolithiasis. High scores of the dotted type and high percentage of cluster type havehigh potentiality of malignant changes. From this study, unknown substances for malignant transformationmight be secreted from the inner epithelium and or intramural glandular epithelium both of which areusually in contact with the infected bile and have chronic irritation from the stones. Extramural glands ofthe bile duct had higher potential for proliferation or malignant transformation in our study. Hence, long-term follow-up study of those patients with hepatolithiasis should be done very carefully especially due tothe possibility of a combination of neoplastic changes in hepatolithiasis.
• 中文關鍵字： hepatolithiasis; cholangiocarcinoma; nucleolar organizer regions.
• 英文關鍵字： --