Matsuki K, Takahashi T, Mohri H
Department of Pathology, Tohoku University School of Medicine, Sendai, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Mar;42(3):346-53.
To study how and to what degree the vascular bed of the lung is narrowed in patients with advanced pulmonary hypertension, the number and density of advanced pulmonary vascular lesions in lung tissue were determined by 3-dimensional morphometry. The material included 17 autopsy lung specimens taken from different lobes of 5 patients ranging from 2 to 17 years and dying of congenital cardiac anomalies. In each specimen, computer-aided 3-D reconstruction was performed from serial sections, and the number of grade 3 and 4 lesions was counted in the computer display, also with their densities calculated. The number and density of obstructive vascular lesions were found varying to an unexpected degree, with a marked difference among the individuals and among the site of the lung. The total number of plexiform lesion tends to be greater in the lower lobes. The degree of vascular bed narrowing, defined as the numerical ratio of the obstructed to the total of what we call "acinar arteries", was also various, suggesting that there can be patients who, having a bed not strongly narrowed, are operable even in the presence of plexiform lesion. On the other hand, the result of morphometry provided a basis on which the reliability of open lung biopsy is to be re-assessed: it disclosed the need of semi-serial sectioning of specimen in order not to be missed plexiform lesions particularly when their density in the lung is very low.
为了研究晚期肺动脉高压患者肺血管床狭窄的方式及程度，通过三维形态测定法确定肺组织中晚期肺血管病变的数量和密度。研究材料包括取自5例年龄在2至17岁、死于先天性心脏异常患者不同肺叶的17份尸检肺标本。对每个标本，从连续切片进行计算机辅助三维重建，并在计算机显示屏上计数3级和4级病变的数量，同时计算其密度。发现阻塞性血管病变的数量和密度变化出人意料，个体之间以及肺内不同部位之间存在显著差异。丛状病变的总数在下叶往往更多。血管床狭窄程度，定义为阻塞的“腺泡动脉”数量与我们所称的“腺泡动脉”总数的数值比，也各不相同，这表明即使存在丛状病变，仍可能有血管床狭窄不严重、可进行手术的患者。另一方面，形态测定结果为重新评估开胸肺活检的可靠性提供了依据：它揭示了需要对标本进行半连续切片，以免遗漏丛状病变，尤其是当它们在肺内的密度非常低时。
