门静脉高压巨脾大部切除后残脾神经分布与定量研究

Distribution and density of nerve fibers in remnant spleen after subtotal splenectomy for splenomegaly due to portal hypertension

目的:观察门静脉高压巨脾大部切除后残脾神经纤维分布与密度变化,评估残脾保留的价值。方法:选取门静脉高压脾肿大行脾大部切除并残脾腹后固定术患者13例,收集患者术后切取的巨脾组织,以及术后8年穿刺获取的残脾组织,另取外伤性脾组织13例为正常对照。采用免疫组化法检测脾神经肽Y(NPY)和神经丝蛋白200(NF 200)阳性神经纤维分布及密度。结果:3组脾组织NPY和NF200阳性神经纤维的分布部位大致相同,但两者在巨脾组织中的密度明显较高。红髓部分的定量分析显示,巨脾组织NPY与NF200阳性神经纤维密度均明显高于残脾组织和正常脾组织(均P<0.05),而两种阳性神经纤维密度在残脾组织与正常脾组织间差异无统计学意义(均P>0.05)。结论:巨脾大部切除术后残脾神经纤维分布及含量与正常脾大致相同,提示解除高压环境后,残脾神经功能能逐渐恢复正常。

Objective： To observe the changes in distribution and density of the nerve fibers in remnant splenic tissue after subtotal splenectomy for splenomegaly due to portal hypertension, so as to evaluate the value of this procedure. Methods： Thirteen patients with splenomegaly due to portal hypertension undergoing subtotal splenectomy with retroperitoneal transplantation of pedicled remnant spleen were selected. The specimens of splenomegaly tissues after surgical resection and the remnant splenic tissues from puncture biopsy 8 years after surgery in these patients were obtained, and specimens of splenic tissues harvested from 13 cases with splenic trauma served as normal control. The distributions and densities of splenic nerve fibers with positive neuropeptide Y （NPY） and neurofilament 200 （NF200） were detected by immunohistochemical staining. Results： The distributions of either NPY or NF200 positive nerve fibers were similar among the three groups of splenic tissues, but the splenomegaly tissue showed a relatively high density of both positive nerve fibers. Quantitative analysis within the red pulp of the spleen showed that the densities of both NPY and NF200 positive nerve fibers in splenomegaly tissue were significantly higher than those in remnant splenic tissue or normal splenic tissue （all P〈0.05）, but there was no significant difference between splenic tissue and normal splenic tissue （both P〉0.05）. Conclusion： After subtotal splenectomy, the distribution and density of nerve fibers in the remnant spleen are approximately the same as those in normal spleen, which suggests that the nerve function in the remnant spleen may gradually return to normal after elimination of the high pressure environment.