光镜、电镜结构及TGF-β表达在未闭合鞘状突中变化的探讨

发布时间：2018-01-28 13:46

本文关键词： 未闭合鞘状突转化生长因子超微结构　出处：《山西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：通过采用免疫组织化学方法观察转化生长因子（TGF-β）在小儿腹股沟斜疝疝囊、鞘膜积液鞘膜囊以及正常腹膜的表达，及其在光镜、电镜下结构的变化，从组织学方面对小儿斜疝、鞘膜积液的发生、发展及自愈机制进行初步探讨。方法：取手术切除的斜疝疝囊颈部、鞘膜积液鞘膜囊颈部各30例，需行腹部手术不伴腹膜炎症患者腹膜10例，采用HE染色观察标本组织病理学变化；用免疫组织化学法检测转化生长因子（TGF-β）在斜疝疝囊、鞘膜积液鞘膜囊和正常腹膜的表达；取1例正常腹膜，5例斜疝疝囊，2例鞘膜积液鞘膜囊在透射电镜下观察组织的超微结构变化。免疫组织化学半定量实验数据结果采用SPSS17.0统计软件进行统计分析。结果:（1）常规病理：对照组正常腹膜表面被覆一层间皮，其下主要由纤维结缔组织、脂肪、血管等组成。斜疝组和鞘膜积液组中，在22％病例中可见有炎症细胞浸润：12％病例可见纤维组织增生明显，，伴玻璃样变，另外，还有部分疝囊中看到平滑肌的存在。（2）免疫组织化学方法检测TGF-β在正常腹膜、疝囊、鞘膜囊组织标本中的表达：其在正常腹膜组、斜疝组及鞘膜积液组均主要表现为弥漫性中度染色(50.0%，50.0％，46.6%)；各组之间差异无统计学意义(χ~2=0.854，P0．05)。（3）超微结构：正常腹膜表面由单层扁平间皮细胞组成，细胞核呈扁平状，不规则，胞浆含量较少，在其腹腔侧可以见到微绒毛，呈卷曲形状。在间皮细胞内可见胞饮小体，多呈现圆形或卵圆形。间皮细胞下有一层基底膜，膜下由大量纤维结缔组织组成，其中可见细胞、脂肪、血管等。斜疝组的疝囊结构与正常腹膜比较，存在不同程度的变化。在1例疝囊仅见腹膜微绒毛完全消失，但是间皮细胞尚完整；在3例疝囊中可见间皮细胞脱落，甚至缺如，仅见基底膜或其下纤维结缔组织。另外，在1例疝囊组织可见大量排列规则的平滑肌。2例鞘膜积液组鞘膜囊观察到腹腔侧微绒毛消失，但是间皮细胞完整，其下由纤维结缔组织组成。结论:转化生长因子（TGF-β）与小儿斜疝和鞘膜积液发生、发展可能不存在直接关系。未闭合鞘状突结构的变化可能与其闭合过程有关，在小儿斜疝和鞘膜积液自愈过程中发挥作用。这可能为临床治疗方法提供新的思路。疝囊上平滑肌的发育异常可能与小儿斜疝的发生有关。
[Abstract]:Objective: by using immunohistochemical method to observe the transforming growth factor (TGF-) in pediatric inguinal hernia, hydrocele sac and normal expression of the peritoneum, and in the light microscope, the structure change under electron microscope by histology of inguinal hernia, hydrocele of the occurrence, development and self-healing mechanism to explore.
Methods: surgical resection of neck hernia, hydrocele sac neck 30 cases, underwent abdominal surgery without peritoneal peritonitis in 10 cases, HE staining was used to observe the changes of tissue pathology detection; transforming growth factor Immunohistochemistry (TGF- beta) in hernia, hydrocele expression sac and normal peritoneum; 1 normal peritoneum, 5 cases of indirect inguinal hernia, 2 cases of hydrocele sac tissue ultrastructure under the transmission electron microscope. Immunohistochemistry and semi quantitative results of experimental data were statistically analyzed by SPSS17.0 statistical software.
Results: (1) the control group: conventional pathological surface coating a layer of normal peritoneal mesothelial, under which is mainly composed of fibrous connective tissue, fat, blood vessels and other components. Hernia group and hydrocele group in 22% cases, inflammatory cell infiltration, hyperplasia of fibrous tissue in 12% cases with significant hyalinization in addition, there are some see the smooth muscle of the hernia sac. (2) immunohistochemical detection of TGF- beta in normal peritoneum, hernia sac, expression in tissue: in normal peritoneal group, hernia group and hydrocele groups showed diffuse moderate staining (50%, 50%, 46.6%); no statistically significant difference between groups (~2=0.854, P0.05). (3): the normal ultrastructure of the peritoneal surface is composed of single-layer flat mesothelial cells, the nucleus is flat and irregular, less cytoplasm content in the abdominal cavity side can be seen in rolls on Curved shape. In mesothelial cells can be seen in the pinosome, showed round or oval. A layer of mesothelial cells and basement membrane, composed of a large number of fibrous connective tissue membrane, in which cells, fat, blood vessels. The hernia hernia group and normal peritoneal structure, there are different degree of change. Completely disappeared in 1 cases of hernia was observed in peritoneal mesothelial cells of intact microvilli, but visible; exfoliated mesothelial cells, in 3 cases of hernia sac even disappear, only the basement membrane or the fibrous connective tissue. In addition, in 1 cases of hernia sac tissue showed a large amount of the regular arrangement of smooth muscle.2 cases of hydrocele sac were observed group the lateral microvilli disappeared, but mesothelial cells, composed of fibrous connective tissue under it.
Conclusion: transforming growth factor (TGF-) and the occurrence of hernia and sheath effusion in children, there may be no direct relationship. The development of unclosed processus structural changes may be related to the closing process, play a role in the indirect inguinal hernia and hydrocele in children during the healing process. This may provide new ideas for clinical treatment of hernia sac on. Smooth muscle dysplasia may be associated with indirect inguinal hernia in children.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.5

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