门静脉高压巨脾大部切除后残脾红髓笔毛微动脉的比较研究  

A comparative study on penicillar arteriole of red pulp in residual spleen after subtotal splenectomy due to portal hypertension

作　　者：王磊[1] 褚海波 赵建华 徐永波 菅凤国[3] 王涛 王敏 祝筱姬 李坤 

机构地区：[1]潍坊医学院研究生部,261042 [2]解放军第八十九医院普外中心 [3]昌邑市人民医院普外科 [4]解放军第八十九医院病理科

出　　处：《中华肝胆外科杂志》2014年第10期715-718,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨门静脉高压巨脾大部切除后残脾红髓笔毛微动脉（PA）的变化,为保脾术提供理论依据.方法 选取门静脉高压脾肿大患者13例,以术后切取脾组织为巨脾组,术后8年穿刺获取脾组织为残脾组.另取13例外伤性脾组织作为对照组.采用EVG染色和免疫组化（CD34）,光镜下观察PA的形态学改变.结果 残脾组红髓PA密度和平均截面积分别为（7.63±0.13）个/0.15 mm2和（144.32±16.53）个/μm2;巨脾组为（9.53 ±0.15）个/0.15 mm2和（323.52±99.31）个/μm2;对照组为（4.64 ±0.15）个/0.15 mm2和（185.01 ±23.65）个/μm2.残脾组红髓PA密度与巨脾组和正常组比较差异均有统计学意义（均P ＜0.01）;巨脾组与正常组比较差异有统计学意义（P＜0.01）.残脾组红髓PA平均截面积与巨脾组和对照组比较差异均有统计学意义（均P＜0.01）;巨脾组与对照组比较差异有统计学意义（P＜0.01）.结论 巨脾大部切除术有利于消除门脉高压导致脾肿大的始动因素,改善脾脏微血管的重构,并可保留脾脏的免疫功能.Objective To investigate the changes of penicillar arteriole （PA） of red pulp in residual splenic tissue after subtotal splenectomy due to portal hypertension in order to provide evidence for beneficial outcomes of reserved splenic surgery.Methods We analyzed 13 samples of splenic tissue following surgery for splenomegaly due to portal hypertension as our splenomegaly group.We then took biopsies from the spleens of the same 13 individuals after 8 years to analyze as our residual spleen group.Our control group consist of splenic tissue from 13 traumatic spleen patients.All tissues were then analyzed using EVG staining and immunohistochemistry to observe morphology of penicillar arteriole under light microscope.Results A significantly lower density of PA was observed in residual spleen group compared with splenomegaly group （7.63 ± 0.13 pieces/0.15 mm2 versus 9.53 ± 0.15 pieces/0.15 mm2,P ＜ 0.01）,but higher compared with the control group （4.64 ± 0.15 pieces/0.15 mm2,P ＜ 0.01）.Significantly lower average cross-sectional areas of penicillar arteriole was observed in residual spleen group compared with both the splenomegaly group （144.32 ± 16.53 μm2 versus （323.52 ± 99.31） μm2,P ＜ 0.01） and control group （185.0123.65 μm2,P ＜ 0.01）.Conclusion Subtotal splenectomy attenuates initiation factors of splenomegaly due to portal hypertension,improves reconstruction of splenic capillaries,and promotes retension of immune function of the residual spleen.

关 键 词：残脾 门静脉高压 脾肿大 笔毛微动脉 

分 类 号：R657.6[医药卫生—外科学]