巨脾大部切除后残脾巨噬细胞的分布与定量研究

Assessment of macrophages of the residual spleen after subtotal splenectomy for splenomegaly

目的探讨门静脉高压巨脾大部切除后残脾巨噬细胞（mφ）的分布与含量。方法收集门静脉高压症患者巨脾标本13例，术后8年穿刺获取残脾标本13例，另设外伤性脾组织13例作对照。采用免疫组化CD68染色，光镜下观察mO分布并计数。结果残脾组mφ均匀分布在红髓脾索内和附在窦壁上，密度增高，色深染，零散分布在白髓脾小体内，较密集分布边缘区，并见mφ体积增大。残脾组红髓的mφ计数（31．09±9．73）与巨脾组（4．20±0．88）和对照组（7．46±0．86）分别比较差异有统计学意义（P〈O．05）；巨脾组与对照组比较差异亦有统计学意义（P〈0．05）；三组白髓脾小体和边缘区之间分别比较差异无统计学意义（P〉0．05）。结论门静脉高压巨脾大部切除后，残脾红髓内单位像素面积mφ数量明显增加，白髓脾小体和边缘区mφ数量和巨脾、正常脾相同，提示保留的残脾仍具有较强的吞噬功能。

Objective To investigate the distribution and the content of macrophages （mφ） in the residual splenic tissue after subtotal splenectomy. Methods Thirteen patients with splenomegaly due to portal hypertension were studied. The specimens were obtained by operation or puncture biopsy. There were 2 groups： the splenomegaly and the residual spleen groups. The control group consisted of 13 patients with trauma-induced splenic rupture. The samples were sliced, and the distribution and counts of mφ were observed under light microscopy using immunohematological staining. Results The mφ of the residual spleen were equally distributed in the splenic cord and they adhered to the wall of the splenic sinus in the red pulp. They had a high density and were deeply stained. In the white pulp, the mφ were scattered in the splenic corpuscle and were significantly concentrated in the marginal zone （MZ）, where larger mφ were found. There was a significantly higher number of mφ in the red pulp of the residual spleen group when compared with the splenomegaly and the control groups. There was a significantly higher number of mφ in the red pulp of the control group （7. 46±0.86） when compared with the splenomegaly group （4.20!0.88） or with the residual spleen group （31. 09±9.73）. A significant difference was not observed among the three groups in the white pulp （splenic corpuscle and MZ）. Conclusions After subtotal splenectomy for splenomegaly due to portal hypertension, the number of unit area of mφ in the red pulp in the residual spleen increased significantly, while the number of mφ in the white pulp did not change much in the three groups of patients. The results suggested that residual spleens still have good phagotrophic functions.