腹腔镜胆囊切除术中电热损伤肝细胞的病理学改变

目的:研究腹腔镜胆囊切除术中电凝电切热损伤胆囊床局部肝组织的病理学改变。方法:取腹腔镜下电刀与剪刀切除胆囊后胆囊床底部边缘肝组织1cm×1cm,每组各取6例,标本立即浸入10％福尔马林液固定,石蜡包埋,连续横切片,光镜观察肝细胞的病理学变化。结果:剪切组肝组织标本浅、中、深层肝细胞均正常;电切组浅层(1-4mm)肝细胞发生凝固性坏死,肝细胞被电热溶解,中层(5-8mm)肝细胞明显皱缩,肝血窦扩张,深层(9-10mm)肝细胞变性水肿。结论:LC术中局部肝细胞的电热损伤十分明显,其损伤程度是外重内轻,深度可达1cm的病理学改变。

The pathologic changes of hepatic tissue subjected to electrical heat injury during laparoscopic cholecystectomy

Objective: To investigate the pathological changes of hepatic tissue from the gallbladder bed subjected to electrical cautery during laparoscopic cholecystectomy (LC) .Methods:Hepatic tissue in mass of 1 cm × 1cm was removed from the edge of the gallbladder bed with scissors or electrical cautery respectively. 6 samples were harvested in each group. Treated routinely with 10% formalin and imbedded with paraffin ,the samples were consecutively sliced and observed under light scope.Results: In scissors-removed group, all hepatic tissues in superficial, middle and deep level showed normal appearance, In cautery-removed group, coagulative necrosis and cell lysis in superficial level hepatic tissue(l- 4mm) ,remarkable shrinkage and hepatic sinus dilation in middle level hepato-cytes(5 - 8mm) and hepatocyte deterioation and edema in the deep level(9 - 10mm) ,were observed respectively. Conclusion; Electrical hot injury to the local liver tissue during LC is remarkable, the extent of this injury is in ratio to the depth of exposure to cautery. Liver cells 1cm inferior to the surface would be influenced.