颅内囊性动脉瘤壁弹性胶原网架结构的病理学形态分析

Pathological analysis of the elastic-collagen network of intracranial saccular aneurysmal wall

目的深入了解动脉瘤壁的病理结构,分析颅内囊性动脉瘤壁弹性胶原网架结构(elastic-collagen network of intracranial saccular aneurysmal wall,ECN)的病理性变化及稳定性差异。方法对34例散发颅内囊性动脉瘤标本(破裂动脉瘤组21例,未破裂动脉瘤组13例)和11例正常颅脑肌性动脉(对照组)采用HE染色、弹力纤维染色、免疫组化染色、苦味酸天狼星红-偏振光方法、激光共聚焦显微镜扫描(Confocal)方法,观察各组标本中胶原成分、弹力纤维及平滑肌的分布。结果破裂动脉瘤壁及未破裂动脉瘤壁间,弹力纤维、胶原纤维及平滑肌的形态及分布均可观察到不同程度的变化。结论将颅内动脉壁中贯穿全层的网架支撑结构定义为颅内动脉壁的弹性胶原网架结构,并分为内层ECN及外层ECN,而破裂动脉瘤壁与未破裂动脉瘤壁中各层ECN的形态及分布特点存在较大差异,此差异对动脉瘤的形成及破裂有重要意义。

Objective To reveal the pathological structure of the intracranial saccular aneurysmal wall and analyze the elastic-collagen network （ECN） changes and the effect on situ stabilization. Methods From 2000 to 2004, 34 cases of intracranial saccular aneurysm specimen were collected （13 in the intact aneurysm group and 21 in the ruptured aneurysm group）. The control group including 11 cases of normal cerebral muscular artery specimen. All the specimen were treated with regular HE stain, elastic fabric stain, and immunohistochemistry, picric acid-sirius red-polarized light microscopy. The distribution of collagen, elastic fabric and smooth muscles was observed under laser confocal microscope. Results There was significant difference in the distribution, morphology of elastic fabric, collagen and smooth muscle between normal cerebral muscular artery wall, ruptured and intact aneurysmal walls. Conclusions A supportive network structure which forms almost the whole wall of cerebral artery is defined as elastic-collagen network structure. It is composed of internal and external ECN. There is a significant difference between the ruptured and intact aneurysmal wall in the pathologic changes of ECN morphology and distribution.