A Study About Interstitial Cells Of Cajal,Synaptophysin And Bile Amylase In The Pathogenesis Of Congenital Biliary Dilatation

Objective:This study aims to investigate the expression of interstitial cells of Cajal(ICC),synaptophysin(SY) and bile amylase in the distal cyst of congenital biliary dilatation(CBD) with Todani typeⅠ. Analysis the factors of enteric neurodevelopment of bile and reflux of pancreatic juice,todiscuss the possible mechanisms of pathogenesis in cystic dilatation and fusiform dilatation ofCBD from multi-perspective.Methods:Thirty-eight children with typeⅠof CBD who underwent cyst excision and Roux-Yhepatojejunostomy in children’s hospital of shanxi province between December 2009 andDecember 2011 were studied.Based on the cyst’s morphology,the patients were divided into twogroups:cystic type (group A) and fusiform type(group B). Where practical,diameters/lengths ofdistal/dilate common bile duct were measured on entry to the abdominal cavity and bile wassampled for amylase content.The specimens of distal cyst were obtained as experimental group,and the choledochal specimens were dissected from eleven cases fetal unplanned pregnancies inlate pregnancy termination as control group.All specimens had been routinely fixed,paraffin-embedded and slice,application of rabbit anti-human C-kit monoclonal antibody and rabbitanti-human synaptophysin monoclonal antibody,using MaxVision method to observe thedistribution and expression of ICC and SY in two groups.Five positive region were randomlyselected at higher magnification of each section,and the same time ICC was counted and theBI-2000 medical image analysis system was used to determine the mean optical density (MOD)of SY.The bile amylase levels were measured by using PNPG7method.Data was analyzed withSPSS 17.0 software package.Results:1. Immunohistochemistry under light microscope: (1) Shape of ICC are cambiform orfusiform,which connected with each other by protrusions to form network in control group; ICCin the CBD cyst of the distal distribution were sparse,especially in group A ICC significantlydecreased or disappeared,the remnants of ICC were significantly sparse and network wasdisappeared.(2) The SY antibody densely stained the nerve fibers and synapses in the controlgroup; which was sparse or even absent in group A,whereas the expression wasn’t significantlyreduced in group B. 2. The statistical analysis: the expression of ICC and SY in group A were significantlylower than these in the control group,there were significant differences (P<0.05); the expressionof ICC in group B were lower than that in the control group,there were obvious difference(P<0.05); the expression of ICC in group A were lower than that in group B,there were obviousdifference (P<0.05); the diameters of the distal common bile duct positively correlated withICC.The expression of SY in group B slightly weaker than that in the control group,but nosignificant difference(P>0.05).Bile amylase levels in group B were significantly higher thanthat in group A,there were significant difference (P<0.05).Conclusions:1. ICC was involved in the pathogenesis of typeⅠof CBD,but the pathogenesis betweenthe cystic and fusiform dilatation may vary.2. Abnormal distribution and expression of ICC and SY were one of the importantpathological changes in cystic dilatation with typeⅠof CBD; biliary anomalous neuro-development is involved in the pathogenesis of cystic dilatation with typeⅠof CBD.3. Pancreatic juice regurgitation was one of the important pathological changes in fusiformdilatation with typeⅠof CBD; pancreaticobiliary malunion and pancreatic juice regurgitationwere involved in the pathogenesis of fusiform dilatation with typeⅠof CBD.