人脾破裂损伤时间推断的法医病理学观察

Forensic pathology study of wound age estimation in human spleen rupture

目的观察人脾破裂后不同时间内脾脏组织形态学特点、SMA阳性细胞表达规律和含铁血黄素沉积、巨噬细胞数量的变化规律,为法医实践中脾损伤时间的推断提供依据。方法收集外伤性脾破裂手术切除标本69例,按破裂损伤时间分为0～6 h组、7～12 h组、13～24 h组、25～48 h组、49～72 h组、73 h～7天组、8～14天组、>14天组。常规染色观察破裂出血区边缘组织学变化;免疫组化染色观察破裂出血区边缘SMA阳性细胞表达规律;普鲁士蓝染色观察破裂出血区边缘含铁血黄素数量的变化规律。结果 (1)脾损伤时间6 h内者可见纤维素渗出,个别中性粒细胞浸润;(2)脾损伤时间7～12 h者可见纤维素渗出,大量中性粒细胞浸润;(3)脾损伤时间13～24 h者可见少量SMA阳性细胞稀疏散在分布;(4)脾损伤时间25～48 h者可见较多SMA阳性细胞网状分布;(5)脾损伤时间49～72 h者可见大量SMA阳性细胞自出血区边缘呈放射状长入出血区。经统计学处理,上述各组间SMA阳性细胞数量的差异有统计学意义(P<0.05)。(6)73 h～7天组及8～14天组可见肉芽组织形成;(7)>14天组可见瘢痕形成;(8)正常脾脏组织内可见含铁血黄素,不同破裂损伤时间含铁血黄素含量的差异有统计学意义(P<0.05)。结论判断脾破裂损伤时间应以破裂出血区边缘组织学变化时为主。纤维素渗出、中性粒细胞浸润、SMA阳性细胞数量及分布特点、肉芽组织及瘢痕形成可作为判断脾破裂损伤时间的指标。含铁血黄素沉积对判断脾破裂损伤时间不可靠。

Purpose To research the changes of spleen morphological characteristics, SMA-postive cells,hemosiderin and macrophages in different stages after spleen rupture and to provide evidences for wound age estimation in human spleen rupture. Method 69 cases of splenectomy due to abdominal injury were included, According to its survival time after the rupture of spleen , the injury groups is divided into eight groups： 0 ～6 h,7 ～12 h,13 ～24 h,25 ～48 h,49 ～72 h,73 h ～7 d,8 ～ 14 d, 〉 14 d. The morphological changes were studied using HE staining;changes of the number of SMA-positive ceils around the bleeding area were observed using immunohis- tochemistry staining; the variation of haemosiderin around the bleeding area was observed using Prussian blue staining. Results （ 1 ） Around the edge of wound tissue, fibrin exudated and a small amount of neutrophils infiltrated in 6 h groups. （2） A lot of fibrin exuda- ted and a large number of neutrophils infiltrated in 7 - 12 h groups. （3） A small amount of SMA-positive cells scattered around the edge of the wound tissue in 13 ～ 24 h groups. （4） More SMA-positive cells distributed in network around the bleeding area in 25 ～48 h groups. （5） A large number of SMA-positive cells growed radially into the bleeding area. the difference of each group was statistically significant （P 〈0. 05）. （6） The granulation tissue generated in 73 h -7 d groups and 8- 14 d groups. （7） The formation of scar tis- sue appeared after 14 day. （8） A spot of hemosiderin deposited in the normal spleen tissue, the difference of hemosiderin with diffferent injury time was statistically significant （P 〈 O. 05 ）. Conclusions Spleen morphological characteristics around the bleeding area can used to be main evidences for wound age estimation of human splenic rupture. Fibrin exudation, neutrophils infiltration, SMA-positive cells and its characteristic of distribution, the formation of the granulation tissue and scar tissue can used to be effective evidences for wound age estimation. Hemosiderin is unreliable to wound age estimation of human splenic rupture.