The Pathology Anatomy Study And Its Significance Of Hepatic Duct Around The Cyst Of Hepatic Hydatidosis

Objectives:To reveal the pathology anatomic and function change of hepatic vasa and bile ducts of hepatic hydatid cyst using the methods of clinical anatomy and clinical imageology and pathology. To analyse the mechanism and feature of biliary fistula of hepatic bile duct and then give guidance to operations and to increase the security and feasibility of operation. To give a preliminary discussion of the relation between the pathology anatomic change of hepatic duct and hepatic histiocyte"disappearance"and formation of"exo-adventitia"or exocyst.Methods:1,The method of clinical anatomy: 172 cases of the anatomic change of hepatic vasa and bile duct of hepatic hydatid cyst are observed on the sub advititalpericystectomy to find the characteristic of that change and hepatic hydatidosis with biliary fistula. 2,The method of clinical imageology: 8 patients are given CT multi-projection volume reconstruction of hepatic artery, hepatic vein, portal vein and bile duct before the sub advititalpericystectomy to discover the relation between hepatic vasa around hepatic hydatid cyst, anatomic change of bile duct and hydatidocystis. 3,The method of pathology: Using 40 cases of operational specimen to make pathologic samples and sections of hepatic vasa and bile duct that attach to the hydatid cyst. To observe the relation between hydatid cyst and pathological change of hepatic duct and surrounding tissue by routine HE stain, MASSON stain and immunohistochemistry under microscope. Results:The results of clinical anatomy and clinical imageology show that hepatic vasa and bile duct attach to the hydatid cyst were pressed and disformed, lost their intrinsical anatomical position and courser. They lost the support of the cylindric vasiform and became applanation and firmly attached to the surface of exocyst. The frame of acini hepatis and hepatocyte which were been supported by that ducts were missed and occupied by hydatid cyst. Parts of ducts could be resected in operation because their physiological function were losed.The different position of hepatic hydatid cyst has different trait and incidence of biliary fistula. We can give the clinical types of hepatic hydatidosis with biliary fistula according to these traits. The results of pathology show that the changes of hepatic ducts around the hydatid cyst mainly are fibrosis: increase of fabric in duct wall, narrowing and thinning of caliber, fibroplasia and lymphocytic cell infiltration etc.Conclusions:The hepatic vasa and bile ducts had obvious anatomy change during hepatic hydatid cyst distensibility growth,which can be showed on the three dimensional CT angiography. That ducts can be differentiated to"non-function"duct and"function"duct according to whether they had physiological function.The key points of sub advititalpericystectomy are to differentiate"non-function"duct and"function"duct and to ascertain the clinical type of hepatic hydatidosis with biliary fistula. The pathology anatomy changes of hepatic vasa and bile ducts of hepatic hydatid cyst are the processes of hydatid lasting mechanical force on the ducts and host immunoreaction. That is one of main reasons of the"disappearance"of hepatic histiocyte and the death of hepatic hydatid cyst. In this process, hepatic hydatidosis with biliary fistula is important part. The process of the local action between Hepatic hydatid cyst and host is the process of the tissue organization, fibers encapsulation and calcification.