脾动脉侧支循环研究与保留性脾手术的应用

随着人们对脾脏免疫功能的认识,兴起了保留性脾手术。但是,脾内部血管缺乏稳定性,对脾部分切除如何解决术中出血问题产生很大难度。为此笔者对脾动脉侧支循环进行了研究。发现结扎脾动脉主干后,脾仍然可通过侧支有一定量血液供应,为脾部分切除如何解决术中出血问题,提供了新的手术根据。     

部分脾栓塞对门脉高压血流动力学及脾亢的影响

目的探讨部分脾动脉栓塞对门脉高压血流动力学及脾动脉亢进的影响。方法20例肝硬化门脉高压并脾亢患者,采用Seldinger技术,插管至脾动脉,注入明胶海绵颗粒 欧乃派克6-7ml。分别于术前、术后1月、6月用彩色多谱勒超声检查门脉血管参数,并查血常规变化。结果行2次栓塞8例,其余均一次栓塞,栓塞面积占脾脏40-70%,门静脉(PV)、脾静脉(SV)横径明显缩小,其中SV最大流速与流量均显著下降(P<0.001),外周血白细胞、血小板在术后1月、6月、12月均明显高于术前。结论部分性脾栓塞术后可明显降低门脉压力及改善脾功能亢进。     

中华鳖脾脏椭球的微细结构及其循环特征

目的 观察和分析12只中华鳖脾脏椭球的显微和亚显微结构,阐明其循环特点。 方法 应用光镜和透射电镜技术,结合心脏注射墨水悬液方法,显示脾脏椭球的组成、结构与循环。 结果 中华鳖脾脏白髓由动脉周围淋巴鞘（PALS）和椭球周围淋巴鞘（PELS）两种结构组成,缺乏淋巴小结。红髓包括脾索和脾窦,未发现边缘区。中央微动脉穿出PALS后,呈笔毛状分成数条椭球毛细血管,后者周围由PELS包绕。椭球毛细血管的末端直接开口于红髓的脾索,血流注入脾索,而后穿过脾窦内皮间隙进入脾窦。不同于普通血管内皮,椭球毛细血管内皮一般为立方状,基膜不完整,其外即为椭球结构。椭球壁由支持细胞、椭球相关细胞和网状纤维等构成。常见淋巴细胞和红细胞穿过椭球壁。注射墨水悬浮液后40min,可见整段椭球壁上分布着大量墨水碳粒。 结论 中华鳖脾脏椭球毛细血管相当于哺乳动物的高内皮后微静脉,是淋巴细胞和血细胞进出淋巴组织的重要通道。中华鳖脾脏循环属于开放式循环。     

脾脏对红细胞和血液流变性的影响

采用测量脾动,静脉血的血液粘度和测量脾动,静脉血中红细胞膜在微管中的变形过程的方法,研究了脾脏对红细胞和血液流变性的影响。结果表明：脾静脉血的血液粘度,红细胞变形指数和红细胞聚集指数以及血中红细胞膜的平均弹性模量和平均粘性系数都明显低于脾动脉的相应值。     

20例脾亢患者脾动脉栓塞术的护理体会

部分脾动脉栓塞术是通过部分阻塞脾动脉减少脾动脉血流，降低门脉压力，抑制亢进的脾功能，同时保留了脾脏免疫功能，因此更适用于肝硬化脾功能亢进患者。我院感染科于2012年8月~2013年8月采用脾动脉栓塞术治疗脾亢20例患者，全部患者住院期间均未出现消化道出血等严重并发症，均康复出院。手术前后正确的护理有利于防止并发症的发生，保证手术疗效。     

肝炎后肝硬化性脾动脉瘤的CT表现与手术方式选择的相关研究

目的探讨肝炎后肝硬化性脾动脉瘤的CT征象与手术方式选择的关系。方法回顾性分析61例肝硬化门脉高压性脾动脉瘤的CT表现(部位、数量、大小、门静脉改变、曲张静脉团、门体分流血管网和脾脏改变)、临床特征和手术方式,并进行统计。结果 4例主瘤体位于脾动脉远端、直径1.0~2.0 cm、存在脾肾分流和脾大的患者行主瘤体旷置术+分支小动脉瘤分期栓塞。瘤体切除+脾脏切除+曲张血管团离断术15例中,主瘤体位于脾动脉中段4例和脾动脉远端11例,主瘤体直径大于2.0cm的15例和1.0~2.0 cm的13例,门静脉海绵样变4例、脾胃静脉曲张5例,食管胃底静脉曲张15例,脾胃肾静脉分流4例,巨脾15例和脾梗死4例。瘤体切除+分支小动脉瘤分期栓塞7例,主瘤体位于脾动脉近段7例,主瘤体直径1.0~2.0 cm 7例,食管胃底静脉曲张2例,脾大7例。4例单发、瘤体直径1.0~2.0 cm、脾大患者行瘤体切除+重建脾动脉连续性,其中脾动脉近端1例、中段2例和远端1例。结论可根据脾动脉瘤的部位、数量、大小、门静脉改变、曲张静脉团、门体分流血管网和脾脏改变结合患者年龄、性别、体重指数及病史选择手术方法。     

脾外伤手术的局解浅析

我院自１９９４年１２月至１９９７年２月共收治脾外伤性破裂２７例。根据脾脏的脾叶动脉，脾段动脉的分型，以及脾损伤情况，而分别采取脾叶、段切除术，脾修补术，脾切除术。从中发现脾的损伤与脾脏的局部解剖有关，同时脾门的脾叶动、脾段动脉的解剖分型对手术方法的选择有指导意义 。     

脾异位移植到髂内动脉有关数据

近年来,脾脏与机体免疫之间的重要关系已被重视,脾切除后的患者“脾切除后急性暴发性感染”(OPSI)和败血症发病率较正常人明显增高。为此,临床已开展全脾异位移植手术。关于全脾异位移植的血循环重建方式,多将受体的髂内动脉或其分支与脾动脉行端端吻合,脾静脉与髂总静脉端侧吻合。为提供有关血管管径数据,我们在30侧经常规防腐固定     

失血性休克对脾免疫功能和超微结构的影响及脾脏在MOF中的可能作用

实验取健康家犬27只,雌雄不拘,随机分为休克组、假休克组和休克治疗组 。休克组和休克 治疗组动物分别按Weiggers法复制成失血性休克模型,于休克后和休克治疗后2 h取颈动脉 血 、脾静脉血和脾组织匀浆测定血浆和组织中IgG、IgA、IgM、C3、C4、TXB2、6 kPGF1 α、IL-2 、IL-6、IL-8、TNF含量,取血后,放血处死动物,取脾标本3%戊二醛和1%锇酸双重固定后 制样电镜观察。实验结果表明： 1.失血性休克后动脉血浆IgG、IgM、IgA水平增高;脾静脉血浆中除IgG降低外,IgM和IgA 水平增高;脾组织匀浆中除IgM和IgA轻度降低外,IgG、C3、C4水平增高。经氧合液复苏后 上述指标均有改善,IgG、IgM水平增高,C3、C4水平降低。 2.失血性休克后动脉血浆中TXB2、6 keto-PGF1α含量均显著增高;休克后脾静脉 血浆TXB2含量显著降低,而6 keto-PGF1α水平增高。切脾对TXB2生成无影响, 而对6　keto-PGF1α 的生成有一定影响。 3.失血性休克后动脉血浆中IL-1、IL-6、IL-8、TNF水平均显著降低,仅IL-2水平增高;休 克后脾静脉血浆中IL-1、IL-2、IL-6、IL-8和TNF水平显著降低;休克后脾组织中IL-1明显 降低,IL-2和TNFα水平明显增高,IL-6和IL-8介于其他两组之间。 4.失血性休克后脾脏超微结构显示,脾内巨噬细胞、淋巴细胞和浆细胞肿大,核变圆,胞 浆空泡化,内质网扩张排列紊乱,细胞间质呈空网状改变,部分细胞有不同程度坏死,核固 缩畸形,核膜模糊,巨噬细胞内多见吞噬现象。 以上结果表明,失血性休克对脾脏的免疫球蛋白、补体、前列腺素和细胞因子的生成和释放 都有一定影响,对脾的超微结构也有不同程度损伤。由此可见,失血性休克可导致脾脏功能 失调和结构破坏,进而造成脾的屏障作用减弱,肠源性毒素乘隙入血,造成除脾以外的多种 器官功能障碍,出现多器官衰竭。所以说脾脏似乎是循环系统一个闸门,失血性休克可以导 致闸门开启,导致过量的毒素和细菌犹如失控的洪水进入血液,造成严重的多器官功能衰竭 。     

脾动豚分段解剖学及其临床应用

对200例人脾动脉进行了观察和测量。据脾动脉分出脾叶动脉及脾段动脉的支数,一般分为两叶(76.7％)四段(65.0％)。脾段动脉通常与脾脏的长轴相垂直,经脾门进入脾内,分为2支(42.1％)或3支(43.7％),放射状地走向脾脏的膈面,是节段分布。相隣脾段之间,血管细小重叠交错,相隣脾叶之间,血管相对稀少。脾段血管的间隙,并不完全与脾切迹相一致。     

脾形态,脾动脉支及脾段的观察

观察经常规固定的100例成人脾,形态可分五型。共出现312个脾切迹,平均每个脾3.12(0～9)个。位于脾前缘切迹的延长线通过脾无血管区者162(60.67％)个。脾动脉主干远距分支(分支点距脾门21mm以上)82例,近距分支(20mm以下)12例,不分支者6例。脾穿动脉共出现685支,平均6.85(2-12)支,其中以6、7、8支者多见。80例剥制脾结构观察,脾叶、脾段和无血管区排列分明者59例(73.7596)。脾段呈3～7个,其中4段脾最多见为34例(57.63％)。典型两叶四段脾31例。A、B、C三条假设线通过无血管区以B线最高,达80.25％,在两叶四段脾中B线通过无血管区高达90.32％。根据脾形态结构,本文对脾部分切除术提出一些建议。     

THREE CASES OF PRIMARY SPLENIC LYMPHOMA

Three cases of primary splenic lymphoma (two diffuse large cell (DL) lymphomas; and one follicular mixed small cleaved and large cell (FM) lymphoma according to the Working Formulation) are presented. Histologically as well as immuno-histochemically, all were considered to be of follicular center cell origin. Reticulin stains clearly demonstrated that the white pulp was primarily involved both in FM and DLs. Remnants of clusters of dendritic reticular cells were demonstrated immuno-histochemically in one case of DL. Primary splenic lymphomas in the Japanese literatures were reviewed and compared with those in the American literatures. It was found that "a solitary mass" was the predominant gross feature (81%) and "reticulum cell sarcoma" was the predominant histologic type (66%) in Japan. In the United States, lymphosarcoma was the predominant histologic type (39%), reflecting the histologic distribution of nodal lymphomas, and "homogeneous" or "miliary" was the predominant gross feature (71%). ACTA PATHOL. JPN. 35: 419–435, 1985.     

SPLENIC HAMARTOMA

A 73-year-old female with a calcified splenic mass received exploratory laparotomy and subsequent splenectomy. The histologic diagnosis of the splenic tumor was hamartoma associated with secondary cystic degeneration and calcification of the cyst wall. The tumor was composed of red pulp-like and white pulp-like areas. The former contained many plasma cells and hyalinized trabecular vessels, while the main component in the latter was lymphocytes. Splenic hamartoma was first described by R okitansky in 1861 under the name of "splenoma". Usually, this rare tumor is asymptomatic and represents an incidental finding at autopsy. To the best of our knowledge, this is the second case report of splenic hamartoma in Japan. The clinicopathological features of splenic hamartoma are briefly reviewed.     

正常和荷瘤小鼠脾中VV~+细胞的反抑制功能

应用长柔毛野豌豆凝集素(VVL)粘附法,从小鼠脾中分离出对VVL有结合特异性的细胞(VV~+细胞)。VV~+细胞的表型确定为Thy1,2~+,Lyt2~-和L_3T~-_4。功能检测结果表明,VV~+细胞可消除或削弱Ts细胞介导的抑制作用。据此判定,VV~+细胞中富含反抑制T细胞(Tcs细胞)。小鼠在移植肿瘤后,其脾中VV~+细胞水平及其反抑制活性,均显著降低。结果提示,抑制和反抑制调节平衡的失常,可能是导致肿瘤宿主低免疫状态的原因之一。     

胎,婴儿脾的外形与脾叶动脉分布的关系

观察研究了７９例胎、婴儿的脾。在描记脾外形的基础上，求出以脾的最大投影面积与其重的回归方程；记录分析了脾切迹、裂及其与脾内叶、段动脉分布的关系；在３１例胎儿脾透明标本上分离了上、下叶和极段，测算结果主要有：上叶大于下叶者占５８．１％，而上叶小于或等于下叶者分别占２５．８％和１６％，极段一般小于脾大小的１／４。     

慢性低氧脾脂质沉积

目的：探讨慢性低氧脾组织的病理学改变。方法：将Ｗｉｓｔａｒ大鼠喂养在逐渐降低的常压低氧条件下,用氮气和空气的混合气体调节氧含量,氧浓度由常含量逐步降低为１５％,１２％,１０％,８％,最后降为７％,实验共进行１１２天。结果：低氧大鼠体重下降,脾重增加,红髓增生,脾血管壁增厚,脾内出现较多泡沫细胞。白髓减少,脾小体萎缩或消失。结论：长期慢性严重低氧可导致脾脂质沉积,免疫能力下降。     

Scorpion venom polypeptide accelerate irradiated hematopoietic cells proliferation

ObjectiveTo study the effects of Scorpion venom polypeptide (SVP) on the irradiated hematopoietic progenitor cells and the initial research of its mechanism.Methods and materials(1) MTT array was used to select the effective concentration of SVP that had proliferate action on the irradiated early hematopoietic cells (K562), just like the doses of experiment in vitro; (2) The male BALB/c mice were divided into NS control group, SVP IV group and SVP V group. After treatment and sublethal irradiation, the C-KIT and IL-6Rα levels of bone marrow cells were detected by immunohistochemistry and tissue array; (3) The bone marrow cells of the normal BALB/c mice, given to SVP IV and SVP V after different action times respectively, were taken to extract the total proteins inside the cell, the phosphorylated STAT3 protein levels in JAK-STAT signal transduction pathway were detected by Western blot array.Results(1) 30 mg/L SVP IV has an obvious effect to accelerate K562 cell proliferation; (2) The C-KIT and IL-6Rα expression on bone marrow cell surfaces in SVP IV and SVP V groups were negative (control with the saline group, p > 0.05); (3) The phosphorylated STAT3 protein levels in bone marrow cells of SVP IV group had a rise-and-fall trend within 30 min, while the test of SVP V group showed that the phosphorylated STAT3 protein levels obviously elevated after 30 min.ConclusionsThe results show that certain SVP IV concentration can protect the hematopoietic progenitor cells after irradiation, and the underlying mechanism of SVP accelerating the hematopoietic recovery in irradiated mice may be related to the activation of the JAK-STAT signal pathway.     

自体移植脾组织内GAP-43神经的生成机制

为探索自体移植脾组织内GAP-43神经的再生机制,将Wistar大鼠42只随机分为实验组和对照组。实验组切除脾脏以后,切取1／2脾脏,切成1 mm×1 mm×1 mm大小的组织块植入大网膜内,术后7、14、30、60、90、120、180 d取脾组织标本通过原位杂交检测GAP-43 mRNA、NGF mRNA和TrkA mRNA,同时进行免疫组化染色观察GAP-43神经。对照组手术松动脾脏,在术后相同时间点取脾组织作对照观察。结果显示:术后30 d检测到移植脾组织内有GAP-43 mRNA、NGF mRNA和TrkA mRNA表达,90 d达高峰后开始下降;术后60 d明显可见GAP~43染色阳性神经纤维,90 d密度最大,主要存在于血管周围,以后无明显改变。结果提示:自体移植脾组织内GAP-43神经再生与内源性NGF和TrkA表达密切相关。     

Origin of defective T lymphocyte-suppressor activating factor interaction in patients with rheumatoid arthritis.

We previously examined the generation of T cell released suppressor activity (TRSA) from peripheral blood T cells from patients with rheumatoid arthritis (RA) in response to a soluble suppressor activating factor (SAF) produced by a 6-thioguanine resistant mutant of the human T cell line CEM. We reported (Lau et al., 1985 Clin. exp. Immunol. 61, 481) that T cells from a substantial proportion of RA patients exhibited impaired TRSA release. To delineate further the TRSA abnormality observed in patients with active RA, we evaluated the kinetics of SAF activation, precursor frequency of SAF reactive cells and quantity of activated SAF released on a per cell basis. The results showed that a lower precursor frequency of SAF reactive cells accounted for defective TRSA release in a majority of RA patients, while TRSA release on a per cell basis was normal. The defective TRSA response to SAF could not be explained by abnormal dose kinetics of SAF, time kinetics of TRSA release or prior in vivo lymphocyte activation of the RA T cells.     

Graft-versus-host disease in murine bone marrow transplantation. II. Modulation of acute and chronic GVHD in mice receiving bone marrow allografts pretreated with immunosuppressive factor derived from a human T cell line

BALB/c bone marrow treated with monoclonal anti-Thy 1.2 antibody and complement is unable to produce prolonged hemopoietic repopulation and survival when transplanted to lethally-irradiated allogeneic CBA recipient mice. Preincubation of the antibody treated bone marrow cells with an immunosuppressive factor (SAF) derived from a 6-thioguanine resistant cell line, itself derived from the human T cell line CEM, in contrast, allowed those bone marrow cells to produce a state of chimerism and long term survival. Parameters designed to gauge the degree of graft-versus-host reactivity (GVHR) in these animals suggested that acute GVHR was abolished with this procedure. Moreover, defining chronic GVHD as associated with abnormally high spontaneous proliferation of splenic cells, elevated anti-host mixed lymphocyte reactivity, or elevated serum immunoglobulin levels (in all cases when compared with the syngeneically repopulated BALB/c----BALB/c), our data suggest that preincubation with SAF modified chronic GVHD also.