巨脾大部切除后残脾的超微结构研究

Ultrastructural assessment of residual spleen after subtotal splenectomy

目的:探讨脾大部切除术后腹膜后长期存在的残脾其内皮细胞、淋巴细胞、巨噬细胞、网状细胞超微结构变化,从微观角度评价残脾免疫细胞的状况。方法:选取门静脉高压症脾肿大行脾大部切除患者8例,采用手术和穿刺活检获取脾组织标本,分为巨脾组和残脾组,另设外伤性脾破裂8例为对照组。制作超薄切片,电镜下观察细胞超微结构变化。结果:1)内皮细胞呈"长杆状"形态,基膜清晰,膜孔存在,胞质内线粒体结构大致正常;2)可见中、小淋巴细胞,形态大致正常;3)部分巨噬细胞出现凋亡现象,核染色质边集,核膜消失及核染色质外溢;4)网状细胞减少,胞体大,核质多,胞内张力丝较清晰,线粒体等细胞器未见异常。结论:残脾脱离高压状态细胞超微结构会发生适应性改变,是残脾免疫细胞功能恢复的基础。

Objective： To investigate the ultrastructural changes of long-time existing the residual spleen after subtotal splenectomy on endothelial cells, lymphocyte, Macrophage, and reticular cells, in order to evaluate immune cells remodeling of the residual spleen. Methods： 8 cases splenomegoly of portal hypertension were Collected. Specimens were obtained by operating and puncturing biopsy, and the splenomegoly groups and residual spleen groups were divided. The other control group was 8 cases of trauma-induced splenic rupture.The thinest slices was made. The ultrastructural change of cells were observed under electrical microscope. Results： 1 ）The endothelial cells were the form of ＂the long rod＂, the basement membrane and the fenestra were clear, the mitochondrial structure roughly normal. 2）The ultrastructure of small and media lymphocytes was roughly normal. 3）The partal macrophage apoptosis which the nuclear membrane have disappeared and the chromatin of cell nucleus have spilled over were appeared. 4）The tonofilament was clear, and the structure of organelles such as mitochondria normal in the reticular cell. Conclusion： Under the residual spleen was departed hypertensive state, the ultrastructure of cells can be occurred adaptive change, it conduce to educe the function of immune cells of the residual spleen.