肝硬化合并肺血管病变——附30例病理解剖分析

CIRRHOSIS OF LIVER COMPLICATING WITH PATHOLOGICAL CHANGES IN PULMONARY VESSELS:WITH ANATOMIC PATHOLOGICAL ANALYSIS OF 30 CASES

随机复查尸检30例肝硬化HE染色肺切片。观察肺泡水平即500μm以下肺小动静脉、毛细血管的分布及变性状态,并将其它病尸检10例作对照。30例中三尖瓣剖开口径扩张>12cm者20%;左右肺重均>对照组;肺淤血100%;肺小动脉变性16.6%,500μm以下肺小动脉数目100倍视野显现增多者73%;扩张肥厚且数目增加、中膜平滑肌增厚者33%(壁厚平均22.57μm);镜下肺胸膜20%局部血管扩张与食道静脉曲张图象相似。如作肺胸膜活检,发现500μm以下肺小动脉及毛细血管有上述所见者有助于肺动脉高压诊断。

HE-stained pulmonary sections of 30 autopsy cases with cirrhosis of liver were reexamined by random. We observed the distribution and degeneration of pulmonary arterioles and veinlets with diameter less than 500μm and capillaries at alveolar level. Ten autopsy cases with other diseases were used as controls. The results showed that the tricuspid orifices were troader than 12cm after being dilated in 20% of 30 cases; The weight of the bilateral lungs wore more than that of controls; there were pulmonary congestion in all cases; pulmonary arteriolar degeneration occured in 16.6% of the cases. The number of pulmonary arterioles with diameter less than 500μm HPF increased in 73%.In 33% of 30 cases, there were hypertrophic dilatation and increasing number of pulmonary arterioles with hypertrophy in medial layer smooth muscles. In 20% of the 30 cases, there were local vasodilatation in pulmonary pleura.The apperance of it under micros.ope was similar to that of cesophageal varices, so we conclude that the above results may be helpful for the diagncsis of pulmonary hypertension complicated in cirrhosis of liver