CAJ | 학술논문

目的探讨移植小肠黏膜的形态学改变规律,以对小肠移植后急性排斥反应(AR)的诊断和治疗提供可靠的依据.方法对5例小肠移植受者术后324个肠黏膜活检样本进行组织学和组织化学检查,并在电镜下观察.结果 5例移植后的肠黏膜组织学改变基本一致,均先后经历再灌注损伤、淋巴回流恢复、AR、肠功能改变等过程.术后0～3个月间3例发生移植肠黏膜活检病理学诊断为不确定(IND)级至轻度(1级)AR4次,术后3～6个月2例发生IND级至1级AR3次,术后7～12个月2例发生中度(2级)AR 4次,重度(3级)AR 2次.AR的一般形态学改变包括移植肠黏膜结构改变、隐窝上皮损伤、炎症细胞浸润等.结论小肠移植后肠黏膜活检是监测AR比较可靠的手段,连续动态地观察可以有效地监测术后AR的发生、发展以及评价治疗效果.对于AR须进行综合性诊断,单一形态学改变不具备特异性.移植肠超微结构改变对判断黏膜屏障功能及确定病原微生物有帮助.
목적 탐토이식소장점막적형태학개변규률,이대소장이식후급성배척반응(AR)적진단화치료제공가고적의거.방법 대5례소장이식수자술후324개장점막활검양본진행조직학화조직화학검사,병재전경하관찰.결과 5례이식후적장점막조직학개변기본일치,균선후경력재관주손상、림파회류회복、AR、장공능개변등과정.술후0～3개월간3례발생이식장점막활검병이학진단위불학정(IND)급지경도(1급)AR4차,술후3～6개월2례발생IND급지1급AR3차,술후7～12개월2례발생중도(2급)AR 4차,중도(3급)AR 2차.AR적일반형태학개변포괄이식장점막결구개변、은와상피손상、염증세포침윤등.결론 소장이식후장점막활검시감측AR비교가고적수단,련속동태지관찰가이유효지감측술후AR적발생、발전이급평개치료효과.대우AR수진행종합성진단,단일형태학개변불구비특이성.이식장초미결구개변대판단점막병장공능급학정병원미생물유방조.
Objective To investigate the continuous pathological features of biopsy specimens from five cases of small bowel allotransplantation (SBT) in order to provide more reliable information for the diagnosis and treatment of acute rejection (AR) in SBT.Methods 324 biopsy specimens of intestinal mucosa after SBT from 5 patients were collected and studied by histology,histochemistry and electron microscopy.Results In the early stage after operation (0～3 months),AR IND-1 grade was diagnosed for four times on 3 of 5 patients.During 3-6 months,AR IND-1 grade for three times was diagnosed in 2 cases,and AR 2 grade for two times during 7 ～ 12 months. All the patients suffered ischemia reperfusion injury, lymphatic vessel reconstruction and AR.Conclusion The pathological examination of biopsy specimens of intestinal mucosa is still the most reliable detecting method to diagnose AR,and continuous observation may play an important role to monitor the occurrence,development,and treatment response of AR. The final diagnosis of AR depends on structure of intestinal mucosa,crypt epithelium injury and inflammatory cells infiltration. The communication among the pathologist and surgeon is the best way to reduce misdiagnoses.Ultrastructural examination is used to verify the pathogenic microorganism.