Abstract:

Objective The study the morphology and pathology of autologous blood cell from patients withtumor 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 the 55 patients with preoperative tumor，36 patients didn't receive fully automaticwashing because of less blood lose. The other 19 patients' total volume of recycled autologous blood cell was 225 ml - 13 900 ml. There were 7 patients who didn't receive autologous blood cell infusion because of blood lose less than 1 000 ml. Among 12 patients whose blood lose more than 1 000 ml，6 cases whose recovery blood cell was much enough to receive fully automatic washing for more than 5 times. At last，there were 10 patients received autologousblood cell infusion while 2 patients were suspected tumor rupture during procedure didn't receive autologous bloodcell 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 andhyperchromatic 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 than 1 000 ml and rupture of the tumor did not during operation.

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 Saver 5 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 225～13 900 ml。失血量＜1 000 ml 的 7 例患者自体血未回输，失血量＞ 1 000 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 1 000 ml 的患者可以考虑回输。