吉林^(192)Ir放射事故患者局部急性放射损伤病理改变

Pathological characteristics of extremely severe acute radiation injury in a patient′s legs and hands after a very uneven accidental exposure to an extremely high dose of 192 Ir.

目的观察一例大剂量全身极不均匀照射急性放射损伤患者数处局部病理改变。方法病理常规切片染色，光镜检查。结果吸收剂量右下肢为３７３８Ｇｙ，左手掌为８３０Ｇｙ，于照射后第８天行右下肢、左前臂截肢术。右手、左膝照射剂量相对较小但难以准确估计，红斑、水肿、水疱、溃疡出现相对较晚，于第５５天行右手指、左膝清创植皮术。镜下：右小腿局部皮肤和皮肤附属器官、皮下组织和骨胳肌广泛地坏死和弥漫性出血，但真皮中的立毛肌尚存；左手指、手掌皮肤表皮细胞空泡变性、坏死，并形成大小不一的囊泡，致使表皮与真皮分离，真皮弥漫性出血、中性粒细胞浸润，汗腺上皮细胞变性、坏死，皮下组织内弥漫性出血，少数脂肪细胞坏死。胫骨、腓骨上端和股骨、桡骨、尺骨下端处骨髓腔内造血组织各系细胞均消失。左膝、右手拇指、食指、中指皮肤示急性放射性溃疡。结论大剂量照射导致的急性放射损伤造成大面积、深达肌肉的软组织坏死及骨髓造血细胞消失。

Objective The pathological characteritics of an extremely high dose radiation in the legs and hands of a patient is reported.Methods Routine section and HE staining.Results The patient was exposed to 192 Ir γ rays for 9 hours and 20 minutes,the activity of which was 2.76TBq.The amputations of the right thigh and left forearm had to be performed 8 days after the irradiation and the debridements and skin graftings were performed on the right hand and the inner side of left knee 55 days after the radiation.Microscopically,massive necroses of cells of the epidermis,cutaneous appendages,hypodermis and skeletal muscles,and haemorrghage in the dermis,hypodermis and skeletal muscles were seen in the local irradiated parts of the right shank.But the arrector pili muscles in the dermis of the right shank remained.On the fingers and the palm of the left hand,vacuolar degeneration and massive necrosis of the cells of epidermis were present with extensive neutrophil infiltration.Cysts of large or small size were formed from the necrotic cells,separating epidermis from dermis.There were degeneration and necrosis of glandular epithelium cells of sweat glands.Haemorrghage was present in dermis and hypodermis.All the hematopoietic tissues in the bone marrow in the upper ends of the tibia and fibula and in the lower ends of the femur,the radius and the ulna disapeared.Acute radiation ulcers were present on the skin of the left knee and on the skin of the thumb,index finger and middle finger of the right hand.Conclusions The extremely severe acute radiation injury caused by extremely high dose of 192 Ir led to the necrosis of the extensive soft tissues deep to skeletal muscles and the disappearace of the hematopoietic tissues in the bone marrow.