【摘要】 目的观察大隐静脉曲张激光凝后超微结构的变化,从亚细胞水平探讨激光治疗曲张静脉的病理学依据。方法激光治疗组,大隐静脉曲张患者20例,采用半导体激光光凝治疗,即刻取光凝后曲张静脉1 cm。对照组,患者20例,采用同期需正常大隐静脉作为移植材料者,在留取移植用正常静脉血管后,剩余部分作为正常对照组。分别行HE染色和电子显微镜超微结构检查。结果激光组,光凝后静脉管壁内膜和中膜直接烧灼处细胞结构完全消失,深达中膜层,邻近区域内膜内皮下空泡形成,趋于死亡或直接脱落,局部形成溃疡,中膜暴露,管腔部位的平滑肌细胞肿胀,呈椭圆形,细胞膜完整性破坏,基板破坏或消失,肌浆网扩张呈空泡状,线粒体肿胀或皱缩。细胞核浓缩,表现为深染变小或细胞核染色质趋边,核膜模糊。弹力纤维内肌丝疏松甚至完全消失,溶酶体增多,出现髓样小体。附近血管壁血小板聚集,见α颗粒,致密核心颗粒、伪足形成,平铺于胶原纤维表面。外膜超微结构无明显变化。对照组,正常大隐静脉分3层,内膜为单层内皮细胞,中膜为平滑肌细胞,细胞器结构清楚,细胞超微结构无明显异常,弹力纤维和胶原纤维完整。结论激光光凝治疗后曲张静脉内膜和部分中膜结构破坏,内皮细胞坏死或脱落,局部溃疡形成,平滑肌细胞核和细胞器均发生病理性改变,血小板聚、附壁,可能是光凝部位静脉血管闭塞的结构基础,从亚细胞水平提供了激光治疗曲张静脉的形态学依据。更多还原

【Abstract】 Objective To observe ultrastructural changes of great saphenous varicosity after the treatment with endovenous laser photocoagulation,and investigate the therapeutic pathogenesis from a subcellsular perspective.Methods The samples were collected from 20 saphenous varicosis patients treated with endovenous laser photocoagulation during the operation,and the normal samples from normal saphenous vein transplantation. All the samples were examined with microscope ad electron microscope.Results The cellular structure disappeared in the cauterized regions. On the other hand,in the neighbor areas,vacuolization was found in and under endothelial cells,and the endothelial cells were near to death or exfoliation,which leaded to the appearance of local ulcers and exposure of smooth mussel cells. The exposed smooth mussel cells were obviously tumid and ellipse in shape. The cellular members were destroyed,and cellular organ changed pathologically. The cellular nucleus were condensed or margined. The platelet was flat with some pseudopods attached to the collagen fiber or vascular walls. Meanwhile,the control veins had a clear structure of three layers,and the cellular members and cellular organs were normal.Conclusions The structure of varicose vein was destroyed after the endovenous laser photocoagulation,the endothelial cells were near to death or exfoliation,the smooth mussel cells’ cellular organ were changed pathologically,and the platelet was attached to the collagen fiber or attached to vascular walls. These findings provided therapeutic basis from a subcellsular perspective.更多还原