芥子气(Sulfur mustard,SM)是一种脂溶性的烷化糜烂性毒剂,被称"毒剂之王".由于其物理和化学性质稳定,在环境中能持久残留,且合成和运输方便,由此成为一种特别有效的化学战剂[1].眼睛是芥子气最敏感的器官,在芥子气接触的人群中会有75％ ～90％不同程度急性和延迟性眼睛受累,芥子气角膜病最为常见.芥子气对角膜上皮细胞伤害作用周转快,代谢率高,且与泪膜的脂质层细胞长期相互作用,引起急性、慢性或迟发的破坏性病变[2-3].芥子气角膜损伤的病理特征、临床表现及防治措施一直是军事医学备受关注的课题,但目前尚无有效的解毒剂.本文对芥子气角膜损伤的特征与防治研究现状作一综述,以便寻找有效的救治措施和防护对策.

The spleen is thought to be central in regulating the immune system, a metabolic asset involved in endocrine function. Overwhelming postsplenectomy infection leads to a mortality rate of up to 50%. However, there is still controversy on performing subtotal splenectomy as treatment of splenomegaly due to portal hypertension in cirrhotic patients. In the present study, immunocytes and the indexes of splenic size, hemodynamics, hematology and immunology in the residual spleen were analyzed to support subtotal splenectomy due to splenomegaly.

Objective To investigate the distribution and the content of macrophages (mΦ) in the residual splenic tissue after subtotal splenectomy.Methods Thirteen patients with splenomegaly due to portal hypertension were studied.The specimens were obtained by operation or puncture biopsy.There were 2 groups:the splenomegaly and the residual spleen groups.The control group consisted of 13 patients with trauma-induced splenic rupture.The samples were sliced,and the distribution and counts of mΦ were observed under light microscopy using immunohematological staining.Results The mΦ of the residual spleen were equally distributed in the splenic cord and they adhered to the wall of the splenic sinus in the red pulp.They had a high density and were deeply stained.In the white pulp,the mΦ were scattered in the splenic corpuscle and were significantly concentrated in the marginal zone (MZ),where larger mΦ were found.There was a significantly higher number of mΦ in the red pulp of the residual spleen group when compared with the splenomegaly and the control groups.There was a significantly higher number of mΦ in the red pulp of the control group (7.46±0.86) when com pared with the splenomegaly group (4.20±0.88) or with the residual spleen group (31.09±9.73).A significant difference was not observed among the three groups in the white pulp (splenic corpuscle and MZ).Conclusions After subtotal splenectomy for splenomegaly due to portal hypertension,the number of unit area of mΦ in the red pulp in the residual spleen increased significantly,while the number of mΦ in the white pulp did not change much in the three groups of patients.The results suggested that residual spleens still have good phagotrophic functions.

Objective To investigate the infiltrative changes of T and B lymphocytes in residual splenic tissues after subtotal splenectomy for splenomegaly.Methods Thirteen patients with splenomegaly due to portal hypertension were studied.The specimens were obtained by operative and percutaneous puncture biopsy.There were 2 groups of specimens from this group of patients:the splenomegaly and residual spleen groups.The control group consisted of 13 patients with traumatic rupture splenic tissues.The samples were sliced,and the distribution and counts of T and B lymphocytes were observed under light microscopy using immunohematological staining.Results In the residual spleen group,the numbers of T and B cell were (59.769±9.429) per 10 5 pixel area,(10.822±1.938) per 10-5 pixel area,while in the splenomegaly group they were (34.715 ± 3.497) per 10-5 pixel area,(2.369±0.664) per 10-5 pixel area,and in the control group they were (48.229±14.869) per 10-5pixel area,(6.844±0.807) per 10-5 pixel area,respectively.A significantly higher number of T and B cells were observed in the residual spleen group when compared with the splenomegaly group and the control group (P＜0.05).Significantly lower numbers of T and B cells were observed in the splenomegaly group when compared with the control group (P＜0.05).Conclusions T and B lymphocytes increased significantly per unit area in the residual spleen after subtotal splenectomy.The results suggested that the immune function of the residual spleen can be improved.

1893年Riegner报道了首例脾切除术,开创了脾脏外科的先河,脾脏外科手术由此拉开序幕[1].随着人们对脾脏解剖及生理功能认识的提高、迷惑的破解、脾脏预言与神话的历史成为现实[2].基于脾切除后凶险性感染的发生率及感染易感性的增加,脾外科派生出脾部分切除术、脾大部切除术,以弥补脾切除所致的脾功能缺陷[3-5].20世纪90年代初,腹腔镜脾切除术(laparoscopic splenectomy,LS)改变了传统的脾手术方法,脾外科迈入微创外科时代[6].随后,LS发展为多孔腹腔镜、NOTES、单孔腹腔镜、机器人等多样化术式,为此欧洲内镜外科协会制定了LS的临床指南[7-15].随着腹腔镜外科的发展与创新,LS已成为血液病脾、外伤脾、脾中度肿大的标准术式[16].近年,脾脏解剖学与免疫学基础理论的突破,给腹腔镜保脾术的发展注入了生机[17].腹腔镜部分脾切除术(laparoscopic partial splenectomy,LPS)、腹腔镜脾大部切除术(laparoscopic subtotal splenectomy,LSS)如雨后春笋般得到迅速发展,脾脏外科由此进入外科艺术时代.与此同时,对外科医生而言,面临着意志与技术的双重挑战[18].现就国外LPS与LSS的研究现状作一概述,与同行共赏.

<正>脾脏是机体最大的外周免疫器官,具有强大的抗感染和抗肿瘤等功能[1-2]。脾脏外科的发展经历了切脾术和保脾术2个阶段。切脾术是脾脏外科发展的初级阶段,保脾术是脾脏外科发展的成熟阶段。通过长期临床实践,脾损伤实施保脾术已被外科医师所共识,血液病实施保脾术仅被外科医师所尝试,对门静脉高压巨脾"切"与"保"一直存在争议[3]。笔者前期研究发现,在静脉高压和缺氧条件下,含血栓曲张大隐静脉管壁可见大量炎症细胞浸润,并参与静脉管壁结构改变的重塑[4-5]。鉴于门静脉高压脾脏呈高血流动力学改变,高压状态脾脏内炎症细胞的浸润分布如何,文献报道甚少,笔者就巨噬细

<正>基质金属蛋白酶(matrix metalloproteinases,MMPs)是一类降解细胞外基质(extracellular matrixc,ECM)的蛋白水解酶家族,其表达受多种因素调控,且作用底物种类之繁多。MMPs及其基质金属蛋白酶组织抑制因子(tissue inhibitor of metalloproteinase,TIMP)通过调节ECM合成与降解的动态平衡,以维持ECM的正常结构与功能[1]。研究表明,下肢静脉曲张的延迟、非愈合、炎症状态可能与MMPs表达上调和细胞因子失衡有关[2,3]。