乳糜尿肾周淋巴管分布规律及临床意义  

The distribution and clinic relevance of lymphatic vessels in the perinephric space of patients with chyluria

作　　者：张银高[1] 王行环[1] 曾俊[2] 罗仪[1] 黄静宇[1] 谭大清[1] 

机构地区：[1]武汉大学中南医院泌尿外科,430071 [2]武汉大学中南医院病理科,430071

出　　处：《中华实验外科杂志》2014年第7期1597-1600,共4页Chinese Journal of Experimental Surgery

摘　　要：目的 观察乳糜尿患者肾周脂肪组织淋巴管的分布规律和结构特征,为改良乳糜尿的手术方式提供解剖学及病理学依据。方法 分别收集6例尸体（对照组）及15例乳糜尿患者（乳糜尿组）手术切除的肾动静脉周围、输尿管上段、肾上腺周围及肾脂肪囊的脂肪组织,行苏木素-伊红（HE）染色和癌胚抗原,M2A单克隆抗体（D2-40）免疫组织化学法观察淋巴管的形态及结构特征,检测脂肪组织中淋巴管密度（LVD）、淋巴管直径及淋巴管面积。结果 对照组肾动静脉、输尿管上段及肾上腺周围脂肪组织内均有淋巴管分布,LVD分别为1.98±0.73、2.14±0.73和2.04±0.56,淋巴管直径分别为（32.13±13.28）、（28.25±7.67）和（27.56±7.91）μm,淋巴管面积分别为（107 854±75 897）、（98 647±36 131）和（897 901±34 911）μm-2,而乳糜尿患者上述区域内LVD（分别为2.97±0.91、3.10±0.88、2.87±0.74）、淋巴管直径[分别为（75.05±39.75）、（64.02±41.92）μm、（40.00±12.05）μm]及淋巴管面积[分别为（222 776±106 624）、（205 551±114 578）、（173 823±89 559）μm-2]均较对照组升高且出现管腔迂曲、扩张等形态学改变,差异有统计学意义（P〈0.05）,其中肾动脉和肾动静脉之间、肾静脉及输尿管上段周围的LVD最高。对照组肾脂肪囊内LVD为1.46±0.22、淋巴管直径为（15.77±5.03）μm、淋巴管面积为（50 223±32 796）μm-2,乳糜尿患者肾脂肪囊内LVD（1.56±0.41）、淋巴管直径[（18.02±6.65）μm]及淋巴管面积[（71 648±50 677）μm-2]与对照组比较差异无统计学意义（P〈0.05）。组内比较显示乳糜尿组肾脂肪囊内LVD、淋巴管直径及淋巴管面积均显著低于肾动静脉、输尿管上段及肾上腺周围,差异有统计学意义（P〈0.05）。结论 乳糜尿的发病机制与肾动静脉、输尿管上段及肾上腺周围脂肪组织内淋巴管数量和形态学改变有关。通过外科手术�Objective To investigate the distribution and morphological features of lymphatic ves- sels in the fat tissue surrounding the kidney and ureter of patients with chyluria and to initially provide the anatomical and pathological supports for the modification of the surgical management of chyluria. Methods The fat tissues surrounding the renal pedicle, kidney and ureter were obtained from 6 adult cadavers and 15 patients with chyluria. The lymphatic vessels were shown by hematoxylin and eosin （HE） staining and immunohistochemieal staining with lymphatic endothelial marker oncofetal antigen M2A monoclonal antibody （D2-40）. The lymphatic vessel density （LVD） , diameter and luminal area of lymphatic vessel were compared between cadavers and patients with chyluria. Results Lymphatic vessels were observed in the fat tis- sues surrounding the renal vessels, ureter and adrenal gland. In the control group, the LVD of the up-men- tioned districts was 1.98±0. 73, 2. 14 ±0. 73 and 2. 04 ±0. 56 respectively; the diameter was （32. 13 ± 13.28） , （ 28.25 ± 7.67 ） and （ 27.56 ± 7.91 ） μm respectively; the luminal area was （ 107 854 ± 75 897 ）, （98 647 ± 36 131 ） and （897 901 ± 34 911 ） μm2 respectively. The LVD （2. 97 ± 0. 91,3.10 ± 0. 88, 2. 87 ±0.74）, diameter [ （75.05 ±39. 75）, （64.02 ±41.92）, （40.00 ± 12.05） μm] and luminal area （222 776 ± 106 624）, （205 551 ± 114 578）, （ 173 823 ±89 559） μm2 ] of lymphatic vessel in the patients with ehyluria were significantly increased as compared with those in the cadavers. The tortu- ous and dilated lymphatic vessels were commonly seen in the patients with chyluria. However, there was no significant difference in the LVD （ 1.56 ± 0.41 vs. 1.46 ± 0. 22 ）, diameter [ （ 18.02 ± 6. 65 ） μm vs. 15.77 ± 5.03 ） μm 3 and luminal area E （71 648 ± 50 677 ） μm2 vs. （ 50 223 ± 32 796 ） μm2 ] of the peri-nephric fat between the patients with chyluria and the cadavers. Among the patients wi

关 键 词：乳糜尿 淋巴管 形态学 分布 

分 类 号：R696.8[医药卫生—泌尿科学]