激光光凝后曲张大隐静脉的组织病理学变化  

Ultrastructural Change of Varicose Great Saphenous Vein after Laser Photocoagulation

作　　者：韩丽娜[1] 王春喜[2] 顾瑛[1] 

机构地区：[1]解放军总医院激光医学科,北京市100853 [2]解放军总医院普外科,北京市100853

出　　处：《中国激光医学杂志》2005年第3期173-176,共4页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的探讨激光光凝后曲张大隐静脉的组织病理学变化。方法采用810nm波长激光器,功率为12W,暴光时间1s,血管内光凝治疗曲张大隐静脉9例,光凝后3h取血管行组织病理学检查,观察光凝后血管结构变化。以正常静脉和治疗前曲张静脉作为对照。结果正常静脉分3层,内膜为单层血管内皮细胞,中膜为平滑肌细胞、弹力纤维和胶原纤维等,外膜为一疏松排列的结缔组织。曲张静脉组织学检查见内膜不完整,内皮细胞之间连接疏松,中膜平滑肌细胞增生、肥厚或萎缩,弹力纤维减少,胶原纤维增多。光凝后管腔内可见大量血细胞,血小板扁平,伸出伪足,贴附于胶原表面;血管内皮细胞和靠近管腔部位的平滑肌细胞结构破坏,细胞浆外溢,和细胞外基质融合;靠近血管腔部位的弹力纤维和胶原纤维断裂,部分脱落于管腔;靠近外膜部位的弹力纤维和胶原纤维和外膜结构没有改变。结论激光光凝治疗曲张静脉的内膜和部分中膜结构破坏,大量血细胞聚集于管腔,促进血小板附着于血管壁。Objective To investigate the ultrastructural change of the varicosis of great saphenous vein after photocoagulation.Methods The varicosis of the great saphenous vein was treated by endovenous photocoagulation with 810 nanometer wavelength laser, 12 W power and 1 second irradiation and the photocoagulated veins were removed 3 hours after treatment to determine the ultrastrutural change compared with the normal veins and the varicose vein before treatment.Results The structure of the normal vein has three layers. The inner layer is vascular endothelial cell, the middle layer is composed of smooth muscle cell, elastic fiber and collagen fiber, and the outer layer is connective tissue. In varicose vein, the intimal membrane became thicker or unintact. In the middle membrane, the number of the vascular smooth muscle cells increased, but their morphology appeared either wilt or flump, and the quantity of elastic fiber decreased while the collagen fiber increased. After the photocoagulation, the structure of the endothelial cell and the smooth muscle cells neart the vascular lumen were destroyed, so the cytoplasm was exosmotic, merging with extracellular matrix. The elastic fiber and collagen splitted thinner or even dissolved. In vascular lumen, there were splits of blood cell and the morphology of platelet was flat with some pseudopods attaching to the collagen fiber. The structure of the middle layer closed to the outer layer and the outer layer looked unchanged.Conclusions It is the vascular epithelial cells and part of the smooth muscle cells that are destroyed during endovenous photocoagulation, which attracted the platelet to stick to the vascular wall.

关 键 词：曲张大隐静脉 病理学变化 血管内皮细胞 组织病理学检查 平滑肌细胞增生 胶原纤维 弹力纤维 曲张静脉 激光光凝治疗 组织学检查 细胞外基质 血细胞聚集 结构变化 结缔组织 细胞结构 血小板 膜结构 激光器 治疗前 内膜 细胞浆 

分 类 号：R454.2[医药卫生—治疗学]