创伤性肠粘连形成过程中腹膜组织变化的形态学观察

目的:通过研究肠粘连形成过程的组织形态学变化,探索肠粘连的可能发病机理。方法:SD大鼠35只,5只作为正常对照,30只按Harris方法形成腹膜粘连模型。分别于术后3小时至7天处死,动态取粘连形成过程中创面部位盲肠浆膜、壁层腹膜和腹膜粘连部位组织,置10%福尔马林固定,石蜡切片,HE染色,光镜观察以上粘连组织形态学改变。结果:1-3天粘连的腹壁和盲肠正常结构破坏,纤维蛋白渗出渐形成一条红染的边缘清楚的粘附带。4-5天表面炎性渗出,以及新鲜肉芽组织形成,间皮细胞减少或消失。6-7天间皮细胞与纤维细胞之间融合在一起,不易辨认出肠与腹膜组织的明确界限,于粘连缝隙的表面可见一层不连续的扁平的间皮细胞。结论:纤维蛋白渗出增加和间皮细胞在腹膜粘连形成中可能扮演重要作用。肠粘连预防的重点放在尽量减少纤维蛋白渗出和促进腹膜间皮的生长可能是值得临床进一步研究和探索的方向。通过观察腹膜粘连的病理改变,对外科手术以及其它创伤所引起的腹膜病变的去粘连有非常实际的理论价值及形态学依据。

OBSERVE THE PERITONEI CONSTITUTION MORPHOLOG DURING THE DEVELOPMENT OF WOUNDED INTESTINE ADHESION

Objective:To survey the possible episode mechanism of the intestine adhesion by study the histomorphology changes during its development . Methods:A total of 35 SD rats, 5 rats used as normal control group,30 others were created to peritoneal adhesion models by the Harris method.The rats were sacrificed one after another during 3 hours to 7 days after the operation,dynamicly got the serous membrane of blindgut, parietal peritoneum and peritoneal adhesion tissue of the wounded area during the desmoplasia.Then fixed in 10% formalin, paraffin section, stained with HE,observed the histomorphology changes of the adhesion tissue above by light microscope. Results:The normal structure of abdominal wall and blindgut were destructed during 1 to 3 days after adhesion,fibrin bleeding and developed into a adhesiveness zone with erythro-stained and clear border.During 4-5 days showed inflamed bleeding on the surface,development of fresh granulation tissue, reduction or extinction of mesothelial cell .During 6-7 days showed mesothelial cell and fibrocyte melted into each other and the verge of intesting and peritonei is not clear.There was a layer of uncontimuous thin andflat mesothelial cell on the surface of adhesion gap. Conclusion:Fibrin effusion increased . Mesothelial cell plays an important role during the development of peritoneal adhesion.As far as possible to decrease fibrin effusion and accelerate peritoneal mesothelium growth should be stressed in the prevention of intestine adhesion and it maybe the direction worthy of further study and explore.There are very practical theory value and morpholog according to get rid of adhesion caused by surgery and other wound by the observation of pathological changes of peritoneal adhesion.