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目的 探讨门脉高压症时脾静脉类粥样硬化改变的发生率、形态及其临床意义。 方法 对尸检正常脾静脉和门脉高压症切除脾静脉各20例进行光镜观察。后者5例斑块进行电镜观察。 结果 正常脾静脉有瓣膜样结构。门脉高压症时脾静脉内膜结节性斑块及弥漫性增厚;中膜显著增厚;外膜多见急慢性炎。斑块以平滑肌细胞增生为主。 结论 门脉高压症时脾静脉皆有类粥样硬化改变,但与动脉粥样硬化有区别。了解脾静脉的病理改变及程度,对脾肾分流术选择合适的术式及吻合口部位以减少吻合口栓塞有一定意义。
Objective To investigate the incidence, shape and clinical significance of splenic atherosclerosis in patients with portal hypertension. Methods Twenty patients with normal splenic vein and portal hypertension with splenectomy were observed by light microscope. The latter five cases were observed electron microscopy. Results Normal splenic vein has valve-like structure. Portal hypertension when the splenic vein nodular plaque and diffuse thickening; medial thickening significantly; more common acute and chronic inflammation of the outer membrane. Plaque mainly smooth muscle cell proliferation. Conclusions There is a kind of atherosclerosis change in splenic vein during portal hypertension, but it is different from atherosclerosis. To understand the pathological changes and extent of splenic vein, spleen and kidney shunt to choose the appropriate surgical procedures and anastomotic site to reduce anastomotic embolism has some significance.