摘要
背景:血管内光凝治疗大隐静脉曲张的机制研究尚少。目的:探讨血管内光凝对曲张大隐静脉超微结构的改变。设计:观察性研究。单位:解放军总医院激光科。对象:2004-01/04,解放军总医院门诊大隐静脉曲张并行血管内激光治疗的患者42例。纳入标准:取踝部明显曲张而无明显血栓形成,表面皮肤完好,无明显营养性障碍的大隐静脉,患者均自愿参加,纳入9例。干预:采用810nm波长激光器,功率为12W,暴光时间1s,血管内光凝治疗曲张大隐静脉,3h后取踝部光凝血管。主要观察指标:行组织病理学检查观察光凝后血管超微结构变化。以正常静脉和治疗前曲张静脉作为对照。结果:正常静脉分三层,内膜为单层血管内皮细胞,中膜为平滑肌细胞、弹力纤维和胶原纤维等,外膜为一疏松排列的结缔组织。曲张静脉组织学检查见内膜不完整,内皮细胞之间连接疏松,平滑肌细胞增生,肥厚或萎缩,弹力纤维减少,胶原纤维增多。光凝后管腔内可见大量血细胞,血小板扁平,伸出伪足,贴附于胶原表面。血管内皮细胞和靠近管腔部位的平滑肌细胞结构破坏,细胞浆外溢,和细胞外基质融合;靠近血管腔部位的弹力纤维和胶原纤维断裂,部分脱落于管腔;靠近外膜部位的弹力纤维和胶原纤维和外膜结构没有改变。结论:激光光凝治疗静脉曲张引起内膜和部分中膜结构破坏。
BACKGROUND:Studies about the mechanism of laser occlusion on the varicose gre at saphenous vein are rare. OBJECTIVE:To explore the ultrastructural changes of the great varicose saphno us vein after it was occluded with laser. DESIGN:An observational study. SETTING:Laser Department of the General Hospital of Chinese PLA . PARTICI PANTS:There were 42 patients with varicose great saphenous veins that were occluded with laser in clinic of the General Hospital of Chinese PLA from January to April 2004.The inclusive criteria:There must be obvious vein tangles beneath the undystrophic skin at ankle without apparent thrombus inside the vein .The patients involved should be voluntary to take part in the study.Finally 9 p atients were enrolled in this study. INTERVENTION:The great saphenous vein was intravenously occluded with laser o f 810 nm and the working power was 12 W and the exposure time was 1 s.The occlud ed vein sample was taken out 3 hours after the occlusion. MAIN OUTCOME MEASURES:The ultrastructure of the occluded vein was observed hi stopathologically.Normal vein and pre treatment varicose vein served as control . RESULTS:The normal vein wall can be divided into 3 layers:the internal layer was composed of the simple endothelial cells;the median layer was composed of th e smooth muscle cells,elastic fibers and collagenous fibers;the external layer w as composed of the loose connective tissues.However,the internal layer of the va ricose vein was incomplete,and the endothelial cells were loosely connected. The smooth muscle cells became hyperplasic,hypertrophic or atrophic.The elastic fib ers decreased in number in contrast to the increase of collagenous fibers.After laser occlusion,in the vein lumen there was a large number of blood cells.The pl atelets became flattened with pseudopods and adhered to collagenous fibers.The e ndothelial cells and smooth muscle cells near the lumen were damaged and the cyt oplasma leaked and fused with extracellular matrix. Broken collagenous and elast ic fibers
出处
《中国临床康复》
CSCD
北大核心
2005年第2期254-256,共3页
Chinese Journal of Clinical Rehabilitation
