巨脾大部切除后残脾红髓笔毛微动脉超微结构的变化

Ultrastructural changes of penicillar arteriole of red pulp in residual spleen after subtotal splenectomy due to portal hypertension

目的 :观察门静脉高压巨脾大部切除后残脾红髓笔毛微动脉(PA)超微结构的变化,探讨高血流动力对脾小血管内皮细胞超微结构的影响。方法:选取门静脉高压脾肿大患者13例,术后切取脾组织为巨脾组,术后8年穿刺获取脾组织为残脾组,另设外伤性脾组织13例为正常组。采用透射电镜观察脾脏红髓PA内皮细胞的超微结构改变。结果:巨脾组PA内皮细胞细胞核结构完整,染色质分布正常,一部分线粒体肿胀,变大变圆,基质变浅,线粒体嵴变短变少,甚至消失;一部分线粒体扁平嵴变成烧瓶状,甚至空泡状,基质致密,出现髓样变。残脾组PA内皮细胞核结构完整,染色质分布正常,线粒体基质均匀,嵴断裂减少,未见空泡样变和髓样变。正常组PA内皮细胞细胞核结构完整,染色质分布正常,线粒体嵴片状排列,外膜连续,基质均匀,连续内膜中可见包裹。结论:巨脾大部切除术可减少残脾血管PA增生,逆转PA内皮细胞线粒体的变化。

Objective： The aim of this study was to observe the uttrastructural changes of penicillar arteriole （PA） of red pulp in residual splenic tissue after subtotal splenectomy due to portal hypertension, in order to investigate the effects of high hemodynamics upon the ultrastructure of the endothelial cells in splenic small vessels. Methods： 13 cases of splenomegaly due to portal hyper- tension which were removed surgically were examined as splenomegaly group. After eight years we obtained another specimens as residual spleen group by puncture biopsy. Then we set 13 traumatic spleen as control group. Samples were made into slices and observed under electron microscopy. Results： in the splenomegaly group, the nuclear architecture of endothelial cell in PA was integrity and the distribution of chromatin was normal. Some mitochondria swelling, large and round, the shallow groundplasm, shorter and less mitochondrial, even disappears were seen; Apptanation crista of some mitochondria turn into a flask, or even was vacuotated. The dense groundplasm and medullary mitochondria was also found. In the residual spleen group, the nuclear architecture of en- dothelial cell in PA was integrity and the distribution of chromatin was normal, the groundplasm uni- formity of mitochondria, less cristae breakage, vacuolus and medullary mitochondria were not ob- served. In the control group, the nuclear architecture of endothelial cell in PA was integrity and the distribution of chromatin was normal. Lamellar mitochondrial cristae arrangement, continuous adven- titia, uniform groundplasm, encapsulation of continuous tunica intima were observed. Conclusytion： For splenomegaly due to portal hypertension, subtotal splenectomy can reduce vasscular hyperplasia （PA） of the residual spleen, and reverse the changes of mitochodria in the endothelial cells of PA.