布-加综合征下腔静脉病变隔膜形态学特征研究  

Morphological features of pathological membrane of inferior vena cava associated with Budd-Chiari syndrome

作　　者：乔师师[1] 党晓卫[2] 徐大千[1] 吴阳[1] 李捷[1] 张红新[1] 陈奎生[1] 许培钦[1] 张水军[1] 

机构地区：[1]郑州大学第一附属医院肝胆外科,450052 [2]郑州大学第一附属医院病理科,450052

出　　处：《中华实验外科杂志》2012年第8期1598-1600,共3页Chinese Journal of Experimental Surgery

基　　金：河南省重点科技攻关计划资助项目（092102310214）

摘　　要：目的观察分析布-加综合征下腔静脉（IVC）病变隔膜的形态学特征，探讨病变隔膜的形成机制。方法大体观察2007年10月至2010年12月根治性切除手术切除的10例布．力口综合行E下腔静脉病变隔膜形态特征，并利用光镜、电镜对比观察病变隔膜与7例正常肝后段下腔静脉壁的组织结构差异。结果术中见病变隔膜位于下腔静脉入右心房2．0cm范围内。隔膜边缘较厚，中央偏薄，表面与IVC内膜相连。9例隔膜下方IVC有附壁血栓，5例病变隔膜局部有钙化。光镜下病变隔膜组织由粗大的均质胶原纤维及成纤维细胞构成，胶原排列紊乱，部分胶原纤维呈透明变性。隔膜边缘为不等程度的纤维结缔组织增生，少量肉芽组织和新生血管等病理改变；正常下腔静脉壁内膜、中膜和外膜3层结构完整。电镜下病变隔膜组织中可见较多的纤维细胞，表面有少量内皮细胞。内皮细胞内线粒体大部分嵴和膜脱落融合、模糊不清或缺失，粗面内质网轻度扩张。偶见凋亡细胞，但体积缩小；正常下腔静脉壁内皮细胞排列规则，呈条带状分布，内皮细胞内可见线粒体、粗面内质网及吞饮小泡，内皮细胞下为少量排列较稀疏的胶原纤维及弹性纤维。结论布-加综合征下腔静脉病变隔膜形成以纤维细胞增生为主，肝后段下腔静脉的损伤和炎症反应可能参与了隔膜的形成过程。Objective To investigate the morphological features of a diseased inferior vena cava （IVC） diaphragm associated with Budd-Chiari syndrome, and to explore the pathogenic mechanisms. Methods Ten patients with a diseased IVC diaphragm associated with Budd-Chiari syndrome underwent radical resection in our hospital frome October 2007 to December 2010. We assessed the gross morphologi- cal features of these diaphragms. The structure of the diseased diaphragms was compared with that of the IVC retrohepatic segment using light and electron microscopy. Results The diseased diaphragms were lo- cated within 2.0 cm from the junction of the IVC and the right atrium. The diaphragms had thick edges and relatively thin centers ; their surface connected with the inner membrane of the IVC. A mural thrombus was observed in the IVC below the diaphragm in nine patients, with partial calcification of the diaphragm in five patients. Light microscopy revealed that the diaphragm was composed of massive homogeneous collagen fi- bers and fibroblasts. The collagen was highly disorganized and some collagen fibers showed hyaline degen- eration. The edges of the diaphragms showed proliferation of fibrous connective tissue, together with some pathological changes, including the presence of some granulation tissue and neovessels. The structures of the normal inner, middle and outer membranes of the IVC remained intact. Electron microscopy revealed the diaphragms contained a relatively high number of fibrocytes, and a small number of endotheliocytes on their surface. Most of the cristae inside the endotheliocytes were disconnected from the inner membranes and fused, and were therefore blurred or missing, The rough endoplasmic reticulum was also slightly dilat- ed. Apoptotic ceils were infrequent, and were generally smaller than expected. The endotheliocytes on the normal IVC walls were well organized, showing a striped distribution. Mitochondria, rough endoplasmic re- ticu｜um and pinocytotic vesicles were found inside the endotheliocytes.

关 键 词：布-加综合征 下腔静脉 病变隔膜 

分 类 号：R575[医药卫生—消化系统]