摘要
目的探讨门脉高压时肝外门脉系统血管结构成分的改变及其临床意义．方法取１５例门脉高压症患者脾动静脉和９例外伤性脾破裂患者脾动静脉，分别作ＨＥ染色、弹力纤维染色、胶原纤维染色和Ｍａｓｏｎ三色染色，采用图象分析技术检测脾动脉、脾静脉壁中弹力纤维、胶原纤维和平滑肌的相对含量．结果门脉高压脾静脉壁增厚，管腔增大，内膜出现不规则的增生，呈结节样斑块，增生的内膜主要为平滑肌细胞，中膜、外膜明显增厚，平滑肌纤维肥厚增生，相对含量增多（Ｐ＜００１），胶原纤维相对含量减少（Ｐ＜００１）．而脾动脉平滑肌相对含量较正常对照组显著增多（Ｐ＜００５），弹力纤维和胶原纤维的相对值较正常对照组无明显差别（Ｐ＞００５）．结论门脉高压症门脉系统血管发生反应性改建，平滑肌增生，胶原相对量下降；脾静脉内膜出现“动脉粥样硬化样”
AbstractAIM Abstract:To evaluate the microstructural changes in human extrahepatic splenic vein and artery in portal hypertension.METHODS Splenic arteries and veins from 15 splenectomized patients with portal hypertension and 9 normal splenic arteries and veins as controls from splenectomized patients with traumatized spleen were investigated. These prepared specimens were stained with HematoxylineEosin, Taenser Jnmas Orcein Van Gieeson and Masson trichrome, respectively. Then the relative contents of elastin collagen and smooth muscle in the splenic arteries and veins were measured with image analysis techniques.RESULTS The splenic vein walls of the patients with portal hypertension were thickened notably and the cavities enlarged. Nodular plaque was found in the intima composed mainly of proliferating smooth muscle cells. The markedly thickened media and adventitia showed compensatory hypertrophy and hyperplasia of smooth muscles. The relative content of smooth muscles increased (P<001) while that of collagen decreased (P<001). There was a significant increase of smooth muscles in the splenic arteries of the patients with portal hypertension (P<001) while the elastin and collagen contents of the patients with portal hypertension were not different from the controls (P>005).CONCLUSION There is a remodeling vascular wall of portal vein system of the patients with portal hypertension in which proliferative smooth muscle is predominant. “Paraatherosclerosis” is found in the splenic veins and the content of collagen decreased relatively.
