原发性脑干损伤组织学诊断要点

目的 探讨人头面部受击致原发性脑干损伤的组织病理学诊断标准。方法 用171例脑干损伤者的脑干颅神经根部作水平切块,HE染色光镜下观察;另取50例非脑干损伤死亡者作对照。并用统计学方法分析两组所见病变。结果 损伤组见脑干浅表部(32.7％-55.6％)或脑干内部挫伤(57.9％-85.9％)、颅神经根部损伤(动眼神经70.2％,面及位听神经53.8％,三叉神经49.7％等)、星形胶质细胞反应性增生、肥大(34.5％-57.3％)及水肿(19.3％-57.3％)改变,与对照组相比,脑干的挫伤、颅神经根部损伤和星形胶质细胞反应性增生、肥大有显著差异(P<0.001),水肿无明显差异(P>0.05)。结论脑干浅表部和/或脑干内部挫伤、颅神经根部损伤及星形胶质细胞反应性增生肥大可作为原发性脑干损伤的诊断依据。

Pathognostic findings of primary injuries on the brain stem

Objective To investigate the features of primary injuries on the brain stem. Methods 171 cases of primary injuries on the brain stem were chosen as experimental group, 50 cases died of other causes without injuries of the brain stem were chosen as control group. Horizontal slices of the brain stem were taken at the roots of cranial nerves, and tissue sections were stained by HE, Results In the experimental group, contusions were observed at the superficial (32. 7% - 55. 6% ) or inner (57. 9% - 86. 0% ) portions of the brain stem. Injuries were detected at the roots of oculomotor (70. 2% ) , facial and acoustic (53.8%) and trigeminal (49.7%) nerves with responsive hypertrophic astrocytes (34.5%-57.3%). Perivascular spaces enlarged, which represented interstitial edema (19.3%-57.3%). Compared with control group, the percentages of contusions of the brain stem, injuries at the roots of cranial nerves and responsive hypertrophic astrocytes were statistically significant (P < 0. 001). Conclusion The appearance of contusion at the periphery or inner of brain stem, trauma of cranial nerves roots, responsive hypertrophy of astrocytes may serve as the evidences of primary injuries on the brain stem.