慢性血栓栓塞性肺动脉高压经肺动脉血栓内膜剥脱术标本的病理取材改良方法  

An improved method for pathological sampling of chronic thromboembolic pulmonary hypertension by pulmonary embolic endarterectomy

作　　者：曹秀雪 常梓怡 钟定荣 王蓓[1] CAO Xiu-xue;CHANG Zi-yi;ZHONG Ding-rong;WANG Bei(Department of Pathology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京中日友好医院病理科,北京100029

出　　处：《诊断病理学杂志》2024年第9期861-865,共5页Chinese Journal of Diagnostic Pathology

基　　金：中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-B-108)。

摘　　要：目的 比较两种取材方法对慢性血栓栓塞性肺动脉高压(CTEPH)的组织病理学特征的观察效果的差异及各类型病变检出率的影响特点,总结CTEPH的病理特点,以期为CTEPH的临床病理研究提供理论依据。方法 回顾性分析北京中日友好医院2016年12月至2023年4月间病理确诊为CTEPH并行肺动脉血栓内膜剥脱术(PEA)的患者的临床病理资料,按取材方式进行分组,一组采用传统取材法,另一组则采用分段式取材法,通过HE染色、免疫组织化学染色及特殊染色方法观察CTEPH内膜病理变化特点,主要病变类型包括血栓、内膜增生、动脉粥样硬化及再通,对比分析两种取材方式下CTEPH的主要病变类型的检出率并对两种取材方法的效果进行统计学比较。结果 分段式取材法对4种主要病变类型均有较高的检出率,且对再通性病变的检出具有显著的优越性。利用分段式取材法,本课题组观察到血栓和动脉粥样硬化这两种病理改变主要出现在CTEPH肺动脉近端,而再通和新生血管多见于远端肺动脉。结论 分段式取材法对CTEPH各主要病变类型的检出效果优于传统取材法。分段式取材法可使病理医师更加全面地对肺动脉不同节段的病变进行观察,从而准确评估CTEPH的病理改变。Objective To compare the effect of two methods on histopathological evaluation of chronic thromboembolic pulmonary hypertension(CTEPH),and the detection rate of various lesion types,in order to provide a theoretical basis for the clinicopathological study of CTEPH.Methods Cases underwent pulmonary thromboendarterectomy(PEA)and pathologically diagnosed as CTEPH retrospectively analyzed and grouped according to different pathological sampling methods:traditional(random)tissue sampling method was used for one group,and segmented sampling approach was used for another group.HE staining,immunohistochemical staining and special staining methods were used to observe the pathological changes of CTEPH specimens.The main types of lesions included thrombosis,neointima,atherosclerosis and recanalization.The detection rates of the main types of CTEPH lesions under the two sampling methods were compared statistically analyzed.Results The segmented sampling method has a high detection rate for the four main types of lesions,and has a significant advantage in the detection of reconstructive lesions.The segmented sampling method could observe that the two pathological changes,thrombosis and atherosclerosis,mainly appeared in the proximal pulmonary vessels,while recanalization and neovascularization were more common in the distal pulmonary vessels.Conclusion The segmented sampling method is better than the traditional materials in histopathological evaluation of CTEPH lesions.Furthermore,the segmented sampling method enables pathologists to observe the lesions of different segments of the pulmonary artery more comprehensively,so as to accurately assess the pathological changes of CTEPH.

关 键 词：慢性血栓栓塞性肺动脉高压 肺动脉血栓内膜剥脱术 病理取材 分段式取材法 

分 类 号：R653.5[医药卫生—外科学]