移植小肠黏膜的组织学观察五例

Morphologic evaluation of biopsy specimens on patients with small bowel allotransplantation： singlecenter experience

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）AR4次，重度（3级）AR2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。

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 ceils infiltration. The communication among the pathologist and surgeon is the best way to reduce misdiagnoses. Ultrastructural examination is used to verify the pathogenic microorganism.