先天性巨结肠不同节段肠壁神经、平滑肌的分布及临床意义

目的 观察先天性巨结肠(HD)不同节段肠壁神经和平滑肌的病变范围,探讨先天性巨结肠根治术后肠动力功能紊乱原因及手术切除结肠范围.方法 用免疫组织化学和苏木素-伊红(HE)染色法,检测20例先天性巨结肠肠壁神经节细胞、神经纤维和平滑肌细胞病理组织学改变及分布范围.结果 巨结肠不同节段肠壁神经节细胞、神经纤维数量及突触素(Syn)、神经节细胞黏附分子(NCAM)的阳性表达,在距扩张远端8 cm虽未达到正常,但与对照组差异减小(P＞0.05).环肌层和纵肌层出现不同程度增厚,在距扩张远端8 cm仍未正常(P＜0.01).肌层出现空泡样变,与对照组比较差异无统计学意义(P＞0.05).结论 先天性巨结肠切除段肠壁神经、平滑肌层均存在病变,在距扩张段的远端8 cm处,两者病变总体缓解.在允许情况下,手术切除结肠的范围应达到或超过此范围.

Distribution of intestinal nerve and smooth muscle cells layers in Hirschsprung's disease and implication

Objective By evaluating the histopathologlcal changes of enteric ganglion cells and smooth muscle cells in the reseeted whole bowel specimens from patients with Hirschsprung's disease (HD)to discuss the mechanism of postoperative dysmotility in HD,and to explore rcsected lengths of whole bowel from HD patients in radical operation.Methods The immunhistochmistry and HE staining were applied to examine the histopathological changes of enteric ganglion cells,nerve fiber and smooth muscle cells in the resected whole bowel specimem from 20 cases of HD.ResulIs The number of ganglion cells and nerqe fibers and expression of Syn and NCAM in circular muscle layer became normal at 8 cm from transitional segments in this study(P＞0.05).Circular muscle layer and longitudinal muscle layer were thickened to varying degrees and were also abnormal at 8 cm from transitional segments(P＜0.01).Vacuolization was detected in highly hypertrophic circular muscle layer of the proximal segments with the difference being not significant between HD group and control group(P＞0.05).Conclusion Hypoplasin of intestinal nerve and smooth muscle cells layers associated with intestinal motility Was seen in the resected intestinal segments of HD.Most of these alterations became slight.when the resected intestinal range became 8 cm from proximal transitional segments.If the patient's physieal system was normal.the the resected intestinal segments should be beyond the rangs.