中国医科大学病理学英文课件3资料.ppt

中国医科大学病理学英文课件3 Still waters run deep.流静水深流静水深,人静心深人静心深 Where there is life,there is hope。有生命必有希望。有生命必有希望1.RegenerationComplete regeneration:Incomplete regeneration:fibrous repair scarPhysiologic:cell renewingPathologic:cell injury regeneration一一.Cell cycle and proliferative potential1.Cell cycle Interphase G1(presynthetic)S(DNA synthesis)G2(premitotic)Mitotic phase(M)Go:quiescent cells in a physiologic state 2.Types(1)Labile cells(continuously dividing C)Definition:continue to proliferate replacing destroyed cells aged cells Cell groups:Stratified squamous cell:epidermis,oral cavity,vagina and cervixThe lining mucosa of respiratory gastrointestinal tract Epithelium of the male and female tractMesothelium cellsHematopoietic and lymphoid cells(2)Stable(quiescent)cells:Definition:These cells not divide or at a very slow rate and undergo rapid division in response to injury.Cell groups:Parenchymal cells of glandular organ:liver,kidneys tubuel epithelial.Mesenchymal cells:fibroblast,osteoblast(3)Permanent(nondividing)cells:Definition:no capacity of regeneration Cell groups:Nerve cells:Neurons destroyed are permanent lost replaced by the proliferation of glial C.Skeletal muscle cellsCardiac muscle cells二、二、Regeneration process of various tissues(一一)Epithelial tissue1.Surface epithelium:Squamous cell basal layer cell proliferation Columnar cell adjacent gland recess cellsproliferation 2.Glandular epithelium:Base membrane intact restored cellBase membrane destroyed difficult Liver:Resected partly liver cell proliferation Necrosis of liver C,reticular framework intact:hepatocyte proliferation restore the structure Necrosis widely,framework collapsed hepatocyte nodular regeneration,FT(二二)Fibrous tissueFibroblast proliferation synthesis collagen derived from quiescent fibrocyte undifferentiated mesenchymal C(三三)BV regeneration1.Capillary:EC budding proteolytic degradation of BM EC budding maturation of EC secrete collagen IV,laminin,fibronectin BM2.Large BV EC proliferation SMC CT proliferationRegeneration of capillary(四四)Cartilage and bone tissue1.Cartilage:proliferation capacity(chondroblast)2.Bone:proliferation capacity(osteoblast)(五五)muscle regeneration Muscle tissue:lower regenerative capacity Muscle fiber spilt completely FTscar(六六)Nervous tissue NC cant regenerate replaced by glial cell glial scarNevous fiber-schwann cell proliferationNevous fiber-schwann cell proliferation 3.Fibrous repair一、一、Form and Functions of Granulation Tissue(一一)Composition1.Granulation tissue:composed of numerous newly formed capillaries and fibroblast,accompanied with inflammatory cell infiltration2.Morphology:(1)Gross:red,soft,granular appearance(2)LM:cap+fibroblast+inflammatory cellsGranulation tissue Granulation tissue(二二)Functions and results1.Functions:(1)Anti-infection and protect wound surface from further injury.(2)Filling wound and the detect area(3)Replacing or encapsule necrosis thrombus,foreign bodies2.Results:GTcap,cell,fFT scar 二、二、Scar（一）（一）Concept granulation tissue CT（二）（二）MorphologyGross：contract,pallor,semitransparent tough less elasticity.LM：composed of collagen parallel fasciculi(hyaline change),less fibrous cells,and BVScarl（三）（三）effect and harm of scar l1benefits：lfilling the wound and ulcer,make tissue,organ intact;stronger resist pull；if lack of elasticityhernia.l2disbenefit and harm:lcontractobstruction.obstruction.lconglutination.lexcess hyperplasia，hypertrophic scar(keloid).三三 wound healing:l1.early change:an acute inflammatory process by the initial injury l2.contraction of woundl3.proliferation of granulation tissue and formation of scarl4.migration and regeneration of epithelium and other tissuesl2.types of wound healingl1)Healing by first intention(wounds with opposed edges)la clean,uninfected surgical incisionl2)Healing by second intention(wounds with separated edges)lmore extensive loss of cells and tissue,as occurs in infarction,inflammatory ulceration,abscess formation,and surface wounds that create large defectsHealing under scar(二二二二)bone fracture healingbone fracture healing 1.1.basic processbasic process hematoma formationhematoma formation：1-21-2daysdays fibrous bone scab formationfibrous bone scab formation：2-32-3days,granulation tissue formdays,granulation tissue form osteal bone scab:osteal bone scab:osblast osblast osloid tissue calcium deposition osloid tissue calcium deposition woven bone woven bone osteal bone scab.osteal bone scab.rebuild or remodelrebuild or remodel:woven woven bone bone ply ply bone bone normal normal relationship relationship normal struture.normal struture.l 2.factors of affect fracture healingl correct reposition timely l firmly fixation timelyl take exercise early,keep local blood supply well.骨痂骨痂骨痂骨痂 NearthrosisCPC病例3l王，男，12岁，因“车祸左小腿疼痛活动受限2小时“入院。患者2小时前被车撞倒在地，当时左小腿弯曲、疼痛，不能活动。入院检查：体温37。C，脉搏100次/分，血压90/60mmHg，左小腿肿胀，短缩，局部有压痛，可触及骨擦感，左小腿不能活动。l B超：腹内脏器未见异常。l 实验室检查：血常规、尿常规均正常。X线检查：左胫骨中下段左胫骨中下段1/31/3斜形完全性骨折，左腓骨上斜形完全性骨折，左腓骨上1/31/3骨折骨折临床处理：临床处理：术后术后X X线报告对位、对线尚可。术后一周线报告对位、对线尚可。术后一周再次复查，结果同前。一月后复查，对位、对线良再次复查，结果同前。一月后复查，对位、对线良好，见少量骨痂形成。牵引一月后改为石膏固定二好，见少量骨痂形成。牵引一月后改为石膏固定二月。月。术后三月复查：术后三月复查：骨骨性性骨骨痂痂形形成成骨折愈合过程组织病理学改变骨折愈合过程组织病理学改变血肿形成：骨折断端间形成血肿血肿形成：骨折断端间形成血肿 血肿机化：幼稚结缔组织含新血肿机化：幼稚结缔组织含新生毛细血管，包围并侵入血肿生毛细血管，包围并侵入血肿纤维及软骨性骨痂形成纤维及软骨性骨痂形成 软骨性骨痂及骨性骨痂形成软骨性骨痂及骨性骨痂形成 Masson染色染色 骨痂形成：软骨细胞肥大，基质钙骨痂形成：软骨细胞肥大，基质钙化，以软骨内化骨的方式成骨。化，以软骨内化骨的方式成骨。骨痂形成：软骨性骨痂以软骨内骨痂形成：软骨性骨痂以软骨内化骨化的方式形成幼稚的编织骨化骨化的方式形成幼稚的编织骨 massonmasson染色染色 骨痂形成：骨痂中新生骨为编织骨小梁表面为成骨骨痂形成：骨痂中新生骨为编织骨小梁表面为成骨 细胞，小梁间纤维组织富于血管。细胞，小梁间纤维组织富于血管。l讨论：l 1.该骨折愈合属于哪种类型的修复？l 2.骨折愈合的基本过程如何？l 3.哪些因素可影响骨折的愈合？病例三答案1.再生性修复2.(1)血肿形成(2)纤维性骨痂(3)骨性骨痂3.(1)复合因素：年龄、营养、内分泌(2)局部因素：感染与异物、局部血液循环、神经、电离辐射 (3)影响骨折愈合的因素：骨折断端的及时、正确的复位；及时、牢靠的固定；早日功能锻炼，保持良好血液供应。