Misra Vatsala, Misra Sri Prakash, Dwivedi Manisha, Singh Premala A, Kumar Vineeta
Department of Pathology, M.L.N. Medical College, Allahabad, India.
J Gastroenterol Hepatol. 2003 Mar;18(3):302-8. doi: 10.1046/j.1440-1746.2003.02980.x.
To do a histomorphometric study of vascular changes in colonic mucosa of patients with portal hypertension (PHT) and to find their association with clinical and upper and lower gastrointestinal endoscopic observations.
Full length colonoscopy was carried out in 55 patients with portal hypertension and 25 controls. Hemorrhoids, anorectal varices and colopathy were carefully looked for and recorded. Two biopsies each were taken from the caecum, ascending colon, transverse colon, descending colon and rectum. Sections from all the five sites were examined for histopathological changes with special reference to changes in mucosal capillaries. Morphometric assessment of the diameter of the capillary and thickness of the capillary wall was performed. These histomorphometric changes were correlated with clinical parameters and findings of upper and lower gastrointestinal endoscopic findings.
Dilated and congested capillaries as well as capillaries with irregular thickening of the wall were seen in a significantly higher number of sections from patients than controls in biopsies from all the five sites from caecum to rectum. On morphometry, the diameter of the capillaries and the thickness of the capillary wall in biopsies from all the five sites in patients was significantly higher than that in the control group. Apart from vascular changes, edema and inflammatory infiltrate in lamina propria were the other significant histological features noted. No significant association between clinical and endoscopic features and histomorphometric assessment was found.
Dilated tortuous mucosal capillaries with irregular thickening of wall, edema of lamina propria and mild chronic inflammatory infiltrate are the major histopathological changes seen in colonic biopsies of patients with PHT, showing that PHT produces changes in the colonic mucosa similar to those seen in the mucosa of upper GI tract. However, the histological changes had no correlation with the clinical or endoscopic findings except that the thickness of the capillary wall was higher in patients who had undergone endoscopic sclerotherapy as opposed to those who had not received sclerotherapy.
对门静脉高压（PHT）患者结肠黏膜的血管变化进行组织形态计量学研究，并探讨其与临床及上、下消化道内镜观察结果的相关性。
对55例门静脉高压患者和25例对照者进行全结肠镜检查。仔细查找并记录痔疮、肛门直肠静脉曲张和结肠病变情况。分别从盲肠、升结肠、横结肠、降结肠和直肠各取两块活检组织。对所有五个部位的切片进行组织病理学检查，特别关注黏膜毛细血管的变化。对毛细血管直径和毛细血管壁厚度进行形态计量评估。将这些组织形态计量学变化与临床参数以及上、下消化道内镜检查结果进行相关性分析。
在从盲肠到直肠的所有五个部位的活检组织中，患者切片中出现扩张、充血的毛细血管以及管壁不规则增厚的毛细血管的数量明显多于对照组。形态计量学分析显示，患者所有五个部位活检组织中的毛细血管直径和毛细血管壁厚度均显著高于对照组。除血管变化外，固有层水肿和炎性浸润是观察到的其他重要组织学特征。未发现临床和内镜特征与组织形态计量学评估之间存在显著相关性。
扩张迂曲、管壁不规则增厚的黏膜毛细血管、固有层水肿和轻度慢性炎性浸润是门静脉高压患者结肠活检组织中主要的组织病理学变化，表明门静脉高压在结肠黏膜产生的变化与在上消化道黏膜中所见相似。然而，组织学变化与临床或内镜检查结果无相关性，仅接受内镜硬化治疗的患者的毛细血管壁厚度高于未接受硬化治疗的患者。
