肝海绵状血管瘤超微结构及其与临床特征的关系  

Ultramicrostructure of hepatic cavernous hemangioma and its correlation with clinical characteristics

作　　者：孙晓力[1] 李国威[1] 扬少毅[2] 刘清峰[1] 王志亮[1] 李宗芳[1] 

机构地区：[1]西安交通大学医学院第二医院普通外科,陕西省西安市710004 [2]西安交通大学医学院电镜室,陕西省西安市710051

出　　处：《世界华人消化杂志》2006年第32期3107-3110,共4页World Chinese Journal of Digestology

基　　金：陕西省科技攻关项目;No.99K13-G28

摘　　要：目的:从肝海绵状血管瘤(CHL)超微结构探讨CHL组织起源,以及组织结构与临床特征关系.方法:对8例CHL切除标本进行电镜观察.1例按常规电镜样品制备,7例用弹力纤维特异染色的丹宁酸块染后,按常规电镜样品制备,经LKB-V超薄切片,用透射电镜H-600,JEOL-100SX和扫描电镜KYKY-2000进行观察.结果:血窦腔由单层内皮细胞覆盖,血窦腔蜿蜒迂回,呈迷宫状结构组成.正常内皮细胞为扁平状,细胞器减少,有吞饮小泡和微丝,细胞间有紧密连接和桥粒连接.内皮细胞下有弹力纤维,中膜层可见成纤维细胞和平滑肌细胞,中、外膜层有丰富胶原纤维.此与微动脉结构相似.CHL内皮细胞多肿胀,核仁边移,突向血窦腔成柱状.随程度加重,粗面内质网囊泡样改变,直至内皮细胞由内膜层脱落,坏死.间质中大量胶原纤维增生,分割弹力纤维,并可由内皮细胞缺损处填充于血窦腔内,发生纤维化.瘤体中无正常肝细胞和肝窦结构.由于瘤内无肝小叶,所以瘤体无双重供血组织结构,CHL由动脉供血.蜿蜒迂回、迷宫样血窦腔,可以解释影像学特征(肝血管造影、CT增强).内皮细胞退行性变化和间质中胶原纤维大量增生,导致CHL纤维化,并自行萎缩.结论:CHL血窦腔结构类似微动脉,起源于肝脏微动脉血管畸形病变.CHL一般不需手术治疗,也不易自发破裂出血.AIM： To explore the origin for cavernous hemangioma of the liver （CHL） from the angle of ultramicrostructure, and probe the relationship between CHL ultramicrostructure and the clinical characteristics. METHODS： A total of 8 CHL samples were selected, 1 of which 1 was prepared using routine method, while the other 7 samples was firstly stained by scytodepsic acid before routine management. After the ultrathin sections were prepared by LKB-V ultramicrotome, transmission electron microscope H-600 and JEOL-100SX and scanning electron microscope KYKY-2000 were used to observe the changes of tissue ultrastructure. RESULTS： In CHL samples, endothelial cell monolayer covered the inner wall of blood sinus which was circuitous and showed labyrinthlike structure. The normal endothelial cells were thin and flat with pinocytotic vesicle, microfilament and fewer cell organelles. There were tight and bridge corpuscle junction. Elastic fibers were located under the endothelial cells, while collagenoblasts and smooth muscle cells were observed in tunica media. Collagen fibers were rich in tunica media and theca externa. These structures were similar to those of arteriole. The endothelial cells of CHL tissues were swelled with nucleoli moving aside, and pillar-like blood sinus existed. Cystoid changes of rough endoplasmic reticulum lasted till the necrosis of endothelial cells occurred. A great amount of collagen fibers proliferated in interstitial substance, which divided the elastic fibers and filled the blood sinus cavity in the position of necrotic endothelial cells through fibrosis. There was no normal hepatic cells and sinus hepaticus in CHL tissues. There were no hepatic lobules in CHL, and double blood-supply system didn＇t exist. CONCLUSION： CHL is caused by vascular malformation of liver arteriole, and the bloodsupply of CHL is through artery. Circuitous and labyrinth-like structure of the blood sinus cavity can elucidate the characteristics of its imaging results, including hepatic angiography and com

关 键 词：肝海绵状血管瘤 超微结构 血供 破裂 纤维化 

分 类 号：R735.7[医药卫生—肿瘤]