目的检测曲张大隐静脉管壁各参数，并探讨曲张大隐静脉管壁发生、发展过程中组织形态学特征与临床病期之间的关系。方法回顾性分析我院2008年7月至2009年7月期间收治的49例高位结扎剥脱加旋切治疗的大隐静脉曲张患者的临床资料，按临床CEAP分级分为单纯静脉曲张组(C2~C3级，简称单纯曲张组），24例; 静脉曲张并皮肤改变组(C4~C6级，简称皮肤改变组），25例; 另选6例因外伤行截肢术但大隐静脉正常无损伤者作为对照组。采用Masson染色测量静脉内膜和中膜厚度，以测量静脉截面的最大直径作为管腔内径值，采用免疫组织化学SP法观察静脉管壁的结构变化。结果管腔内径: 与对照组比较，单纯曲张组及皮肤改变组上、中、下三段静脉管腔内径均明显增大(Plt;0.05); 皮肤改变组上、中段静脉管腔内径较下段也明显增大(Plt;0.05); 单纯曲张组三段静脉管腔内径变化差异无统计学意义(Pgt;0.05)。单纯曲张组和皮肤改变组的静脉管壁结构改变大致相似，主要表现为内膜不均匀增厚，管壁厚薄不等，以胶原纤维和细胞外基质增生为主，伴有平滑肌增生，中膜厚度略增加，平滑肌束排列紊乱，部分萎缩、凋亡，部分局灶增生，肌束间纤维胶原间质增生，两者相互穿插，排列混乱，弹力纤维断裂。皮肤改变组还可见内膜继发性改变，包括黏液变性、玻璃样变性、内膜炎、血栓形成等。单纯曲张组和皮肤改变组上、中、下三段静脉内膜厚度明显大于对照组(Plt;0.05); 单纯曲张组上、下段静脉内膜厚度明显小于中段(Plt;0.05); 单纯曲张组中段内膜厚度明显大于皮肤改变组中段(Plt;0.05)。中膜厚度单纯曲张组、皮肤改变组和对照组之间以及同一组内上、中、下三段间比较差异均无统计学意义(Pgt;0.05)。结论下肢曲张静脉管腔扩张，内膜增厚，内膜改变以中段出现较早且显著，上、下二段血管壁的重塑与临床病期之间无关。
ObjectiveTo observe the ultrastructural changes of vasa vasorum endothelial cells in the walls of the great saphenous vein and splenic vein, and to evaluate the effect of high hydrostatic pressure and hypoxia upon vasa vasorum endothelial cells. MethodsThirty-four varicose great saphenous vein samples and splenic vein samples with portal hypertension were obtained, and the same number of normal great saphenous vein and splenic vein were used as the control groups. Semi-thin sections stained with HE staining vasa vasorum of the adventitia in great saphenous vein and splenic vein were observed for light microscopy. Samples were made into ultrathin-slices again. The ultrastructural changes of endothelial cells were observed under transmission electron microscopy. ResultsIn varicose great saphenous veins and diseased splenic veins, the nuclear architecture of endothelial cells in vasa vasorum were integrity and the distribution of chromatin were normal. In some mitochondria, the trachychromatic groundplasm, undefined and ruptured cristae were found. ConclusionUnder high hydrostatic pressure and hypoxia conditions, the ultrastructure of vasa vasorum endothelial cells between the great saphenous vein and the splenic vein may appear remodeling phenomenon, and both changes are similar.