肿瘤患者肝移植术中回收自体血细胞形态及病理学研究

摘要

目的：对肿瘤患者肝移植术中回收自体血细胞进行形态学及病理学研究。方法原位肝移植患者124例，其中肿瘤患者55例。术中应用自体血回收仪（Cell Saver5或5+）进行血液回收，全自动洗涤一次红细胞容量为225 ml，对洗涤后的血细胞进行涂片分析及病理学观察。结果55例术前肿瘤患者中，有36例患者回收血量少未洗涤，19例患者自体血回收、洗涤，回收血液总量为225～13900 ml。失血量＜1000 ml的7例患者自体血未回输，失血量＞1000 ml的12例患者中有6例患者回收血液多，洗涤次数超过5次，最终有10例回输自体血，有2例因为术中切除肝脏肿瘤，怀疑肿瘤破裂最终未输注自体血。所有血样涂片红细胞形态正常，偶有挤压的中性粒细胞、少见淋巴细胞。肝癌细胞在低倍光镜下排列成小梁状、实性巢状、假腺样或腺泡样结构，细胞排列成3～4层厚的小梁或细胞索；高倍镜下，癌细胞大小不一，形态怪异，胞浆丰富，嗜酸性，核圆形，核仁清楚，深染，可单核或多核，偶见破骨细胞样巨细胞，病理学检查未发现肿瘤细胞。结论回收自体血无论从红细胞形态学、肿瘤细胞病理学方面均未发现肿瘤细胞，在术中肿瘤未破，失血超过1000 ml的患者可以考虑回输。%Objective The study the morphology and pathology of autologous blood cell from patients with tumor during liver transplantation.Methods Among 124 patients who underwent orthotopic liver transplantation, 55 patients with tumor were enrolled. Intraoperative autologous blood recovery apparatus(Cell Saver 5 or 5+) was used to collect autologous blood cell. The red blood cell volume of fully automatic washing was 225 ml/cycle. The recycled autologous blood cell was detected by smear analysis and the pathologyof recycled autologous blood cell was observed.Results Among the55 patients with preoperative tumor,36 patients didn't receive fully automatic washing because of less blood lose. The other19 patients' total volume of recycled autologous blood cell was 225 ml -13900 ml. There were7 patients who didn't receive autologous blood cell infusion because of blood lose less than 1000 ml. Among 12 patients whose blood lose more than1000 ml,6 cases whose recovery blood cell was much enough to receive fully automatic washing for more than5 times. At last, there were10 patients received autologous blood cell infusion while 2 patients were suspected tumor rupture during procedure didn't receive autologous blood cell infusion. All the red blood cells showed normal morphology in blood sample smear analysis, and no tumor cells were found in pathological examination. Crushed neutrophils were found occasionally, lymphocytes can be observed rarely. Low power light microscope, liver cancer cells arranged in a trabecular, solid nests, pseudoglandular or acinar structures, cells arranged in three or four layers thick trabecular or cords. At high magnification, the size of the cancer cells varied, morphology of the cancer cells weird, abundant acidophilic cytoplasm, round and hyperchromatic nucleus, nucleolus clear, mononucleated or multinucleated,osteoclastic-like giant cells were observed, occasionally.Conclusion In the samples of recycled autologous red blood cell, no tumor cell was found in the aspects of blood cell morphology or tumor cell pathology. he autologous transfusion can be used for the patients whose blood lose more than1000 ml and rupture of the tumor did not during operation.