肝硬化患者脾静脉和胃冠状静脉壁类粥样硬化样改变

研究肝硬化门静脉高压症患者脾静脉和胃冠状静脉壁类粥样硬化样改变，并探讨其发生机理及临床意义。方法５０例肝硬化门静脉高压症患者，在行脾切除贲门周围血管离断术时取一段脾静脉和胃冠状静脉供研究，１０例十二指肠球部溃疡患者和１０例外伤性脾破裂患者为对照组，行光镜和电镜观察。

Atherosclerosis like changes in splenic vein and gastric coronary vein of cirrhotic patients

Objective To investigate the atherosclerosis like changes in splenic vein and gastric coronary vein of cirrhotic patients, and their pathogenesis and clinical implication. Methods The esophagogastric devascularization with splenectomy were performed upon 50 cases of cirrhosis. The splenic vein and gastric coronary vein were taken during operation and studied morphologically. The 10 cases of peptic ulcer of duodenum and 10 cases of ruptured spleen due to trauma served as control group. Results In the cirrhotic patients, the light microscopy showed the splenic and gastric coronary vein become thicken significantly, the endotheliocytes were not intact, the papilla like or diffuse thick proliferative nodules were observed. There were a lot of smooth muscle cells with disturbed arrangement, fibro connective materials, and some atheronecrosis, broken materials in subintimal space. The smooth muscle cells in midlayer become thicken and migrated to underintima. The electron microscopy showed that broken endothelium, thrombosis to vessel wall, a lot of proliferative smooth muscle cells and collagen fibers in underintima. The phenotype of smooth muscle cells changed from contractile to synthotic type. Conclusion In portal hypertensive patients, the atherosclerosis like plaque was formed due to proliferation, migration and phenotypic changes of SMC, which resulted in the formation of rugged, thick and hard splenic and gastric coronary vein.;