先天性巨结肠的一种术中快速诊断方法

目的 探讨先天性巨结肠的术中快速诊断方法。方法 17例术前诊断为巨结肠的患儿，术中分别在狭窄段、移行段和扩张段取三份全层标本，以直肠肛门畸形患儿结肠造瘘术后关闭瘘口时的结肠标本为正常对照，利用一种快速AchE染色方法，将标本孵育时间分别确定为1、3、5、10、15、30min，同时进行冰冻切片HE染色并和正常组比较。结果 快速AchE染色法标准孵育时间5min后出现深褐色的沉淀，我们可以识别出增生的胆碱能神经纤维，而正常组神经纤维不显色，如果结合冰冻切片HE染色观察神经节细胞使结果更准确。结论 这种简单而可靠的快速AChE染色方法可以和冰冻切片HE染色联合应用在术中诊断HD和IND，并判断异常肠段的范围。

A Rapid Method for the Intraoperative Diagnosis of Hirschsprung's Disease.

Objective To explore rapid method for the intraoperative diagnosis of Hirschsprung's disease ( HD ). Methods Seventeen patients were preoperatively diagnosed as having HD who underwent multiple intraoperative full-thickness intestinal biopsies at three levels ( narrow segment, transition zone, and dilated segment ) .Used normal colonic tissue samples from 6 children with rectoanus deformity during closure of fistular orifice postcolostomy as control group. Using a rapid acetylcholinesterase histochemical technique, tissue sections were incubated for 1,3,5,10,15 and 30 minutes, compared with snap-frozen H&E staining and as compared with normal specimen. Results After an optimal incubation time of 5 minutes, using this new rapid AChE method recognized hyperplastic cholinergic fibers with a dark brown precipitate, but the positive nerver fibers were not found in the normal group. The diagnosis would be more convinced when it was combined with frozen H&E staining. Conclutions In combinated with routine frozen H&E staining, this rapid-modified AChE method is a reliable and simple method for intraoperatively diagnosing HD and IND, and could acculately evaluate the range of the affected bowel segment during pull-through surgery