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目的观察一例大剂量全身极不均匀照射急性放射损伤患者数处局部病理改变。方法病理常规切片染色，光镜检查。结果吸收剂量右下肢为３７３８Ｇｙ，左手掌为８３０Ｇｙ，于照射后第８天行右下肢、左前臂截肢术。右手、左膝照射剂量相对较小但难以准确估计，红斑、水肿、水疱、溃疡出现相对较晚，于第５５天行右手指、左膝清创植皮术。镜下：右小腿局部皮肤和皮肤附属器官、皮下组织和骨胳肌广泛地坏死和弥漫性出血，但真皮中的立毛肌尚存；左手指、手掌皮肤表皮细胞空泡变性、坏死，并形成大小不一的囊泡，致使表皮与真皮分离，真皮弥漫性出血、中性粒细胞浸润，汗腺上皮细胞变性、坏死，皮下组织内弥漫性出血，少数脂肪细胞坏死。胫骨、腓骨上端和股骨、桡骨、尺骨下端处骨髓腔内造血组织各系细胞均消失。左膝、右手拇指、食指、中指皮肤示急性放射性溃疡。结论大剂量照射导致的急性放射损伤造成大面积、深达肌肉的软组织坏死及骨髓造血细胞消失。
Objective To observe the local pathological changes of several cases of acute radiation injury in a very large dose of whole body. Methods routine pathological staining, light microscopy. Results The right lower extremity was 3738Gy and the left palmar was 830Gy. The right lower limb and left forearm amputation were performed on the 8th day after irradiation. Right hand, left knee irradiation dose is relatively small, but difficult to accurately estimate, erythema, edema, blisters, ulcers appear relatively late, on the 55th day right hand, left knee debridement dermabrasion. Microscopically, extensive necrosis and diffuse hemorrhage occurred in the local skin and appendages of the right lower leg, subcutaneous tissue and skeletal muscle, but the piloerection of the dermis survived. The left hand fingers and the epidermal cells of the palm skin were degenerated, necrotic and formed The size of the vesicles, resulting in the separation of the epidermis and dermis, diffuse diffuse dermis, neutrophil infiltration, degeneration and necrosis of the sweat gland epithelial cells, subcutaneous tissue diffuse hemorrhage, a small number of fat cells necrosis. The tibia, fibula and femur, the radius, ulna at the lower end of the hematopoietic tissue within the bone marrow cells were disappeared. Left knee, right thumb, index finger, middle finger skin showed acute radiation ulcer. Conclusions Acute radiation injury caused by high dose irradiation causes large area, deep muscle soft tissue necrosis and disappearance of bone marrow hematopoietic cells.