CAJ | 학술논문

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.
목적 탐토문정맥고압거비대부절제후잔비홍수필모미동맥(PA)적변화,위보비술제공이론의거.방법 선취문정맥고압비종대환자13례,이술후절취비조직위거비조,술후8년천자획취비조직위잔비조.령취13예외상성비조직작위대조조.채용EVG염색화면역조화(CD34),광경하관찰PA적형태학개변.결과 잔비조홍수PA밀도화평균절면적분별위(7.63±0.13)개/0.15 mm2화(144.32±16.53)개/μm2;거비조위(9.53 ±0.15)개/0.15 mm2화(323.52±99.31)개/μm2;대조조위(4.64 ±0.15)개/0.15 mm2화(185.01 ±23.65)개/μm2.잔비조홍수PA밀도여거비조화정상조비교차이균유통계학의의(균P ＜0.01);거비조여정상조비교차이유통계학의의(P＜0.01).잔비조홍수PA평균절면적여거비조화대조조비교차이균유통계학의의(균P＜0.01);거비조여대조조비교차이유통계학의의(P＜0.01).결론 거비대부절제술유리우소제문맥고압도치비종대적시동인소,개선비장미혈관적중구,병가보류비장적면역공능.
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.