Banff方案对临床肝移植后急性排斥反应分级的指导作用.pdfVIP

· 76· 植杂志2003年3月第24卷第? ．n』 噍垫! 垫 pJ垫! ．丝 垒： Banff方案对临床肝移植后急性排斥反应 分级的指导作用 于颖彦 沈柏用 周光文 陈皓 严佶祺 彭承宏 李宏为 【摘要】 目的 探讨Banff方案在同种原位肝移植(O )后，对急性排斥反应的评价及分级中 的作用。方法 23例OLT患者围手术期内，在 B超引导下共进行肝穿刺活检20例次，穿刺组织经 中性福尔马林固定，全自动组织脱水机真空／力口压处理，石蜡包埋，4 h内制成高质量 HE染色切片，进 行观察和诊断。严格按照Banff方案进行分级，每例均确保在穿刺5 h内作出病理诊断。对确定为急性 排斥反应的病例，于穿刺当日调整治疗方案，给予额外的免疫抑制剂或皮质激素冲击治疗；诊断为亚 临床型排斥反应者进行密切观察。结果 20例次肝穿刺活检中，6例次提示有急性排斥反应，排斥反 应发生率为30％。经上述处理，所有病例均获缓解，迄今尚无 1例因排斥反应导致移植肝失功。结 论 Ban 方案对OLT后急性排斥反应的评分标准简单明了，可重复性强，便于横向、纵向比较，更有 利于国际学术交流以及网络临床病理讨论分析，值得国内临床肝移植界推广应用。 【关键词】 肝移植；移植物排斥；Banff方案 ApplicationofBanff schemaingrading acute rejectionfollowingtransplantation yUYing-yan．SHEN Bo-yong，ZHOUGuang-zoen，et a1．Department ofSurgery，Ruijin Hospital，ShanghaiSecondMedi— cal University，Shanghai Institute ofl~gestive Surgery，Shanghai 200025，China 【Abstract】Objective Study the application of Banff schema in grading acute rejection(AR)fol— lowing liver transplantation．Methods Perioperatively．20 liver COre needle biopsy specimens out of 23 cases undergoing liver transplantation were obtained under the guidance of B-ultrasound．The biopsy tissues were fixed in 10％ buffered formalin．processed in automatic tissue processing ma chine at vacuum ／high pressure COndition．and embedded by paraffin．HE—stained slides were made withint 4 h for observation and diagno— sis．The grades for AR were ma de by Banff schema．Pathological diagnosis was done within 5 h following biopsy．For those cases diagnosed as having AR，the treating protocol were adjusted at the day of biopsy． However．for thoe,e having subacute rejection，close observation was carried．Results Six out of 20 COre needle biopsy specimens had ACR with the rejection rate in this group being 30％．AIl acute rejection cases had been evaluated and graded strictly by Banff schema．Every case had been signed—out within 5 h after liver needle biopsy．All cases had been cured and no cases developed tO liver dysfunc