先天性巨结肠患儿钡剂残留与Cajal间质细胞相关性的研究  

Relationship between the amount of residual barium after barium enema and the quantity of interstitial cells of Cajal

作　　者：李宁[1] 韦佳[1] 邱银荣[1] 赵文涛[1] 王文美[1] 刘豫隆[1] 冯杰雄[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030

出　　处：《中华临床医师杂志（电子版）》2011年第16期4684-4688,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：教育部留学回国人员科研启动基金(2008-890);湖北省自然科学基金(2007ABA092)

摘　　要：目的通过比较先天性巨结肠患儿钡灌肠检查24h后钡剂残留情况与肠壁Cajal间质细胞(ICCs)数量之间的关系,探讨钡剂残留对判断肠管切除范围的指导意义。方法研究对象为34例在我院诊断为先天性巨结肠并行根治手术的患儿。从每段切除肠管的近端及远端分别取一块标本行HE染色检测神经节细胞。每例患儿另取3块标本做免疫组化染色观察ICCs,分别位于钡剂残留水平以下3～5cm(A组)、残留处(B组)以及残留水平以上3～5cm处(C组)。采用ImagePro-Plus图像定量检测比较三组标本ICCs数量的差异。结果 HE染色示34例患儿远端标本均未见神经节细胞,且近端标本神经节细胞正常。免疫组化染色后ICCs呈棕黄色,主要位于肠壁肌层及黏膜下层中。A组标本肌层中ICCs较稀疏,黏膜下层ICC几乎消失。B组标本ICCs变异度较大,部分标本ICCs丰富,另有部分标本ICCs显著减少。C组标本肌层、黏膜下层中均可见丰富的ICCs。采用ImagePro-Plus测量三组标本照片的平均光密度,结果A组显著低于C组,两者相比差异有统计学意义。采用配对四格表比较两者相关性结果显示,根据钡剂残留判断ICCs减少的特异度为95.5%,敏感度71.7%。结论先天性巨结肠患儿钡剂残留段肠管ICCs减少,巨结肠根治术肠管切除范围应包括钡剂残留段肠管,否则会因保留ICCs异常肠管而导致便秘复发。Objective To figure out the relationship between the amount of residual barium after barium enema and the quantity of interstitial cells of Cajal(ICCs) of the bowel wall and to assess the significance of barium residue on choosing the length of bowel to be resected during pull-through operation.Methods Thirty-four Hirschsprung's disease(HD) children who underwent pull-through procedure were enrolled in this study.During operations,2 pieces of bowel wall were obtained at the proximal and distal ends of each resected sample respectively,for HE staining to exam ganglion cells.Another 3 pieces were obtained and divided into 3 groups,for immunohistochemisty to exam ICCs.Samples in group A were taken from 3-5 cm below the level of barium residue,samples in group B were taken from the level of barium residue,samples in group C were taken from 3-5 cm above the level of barium residue.ImagePro-Plus software was used to compare the amount of ICCs between the 3 groups.Results ICCs in group A were significantly less than in group C,whereas ICCs in group A and group B,group B and group C were not significantly different.The specificity and sensitivity of ratiocinating ICCs by residual barium were 95.5% and 71.7% respectively.Conclusions ICCs are reduced in the bowel segments that hold up the barium.During the pull-through procedure,segments that hold up the barium must be resected,or constipation may recur because of ICCs reduction.

关 键 词：HIRSCHSPRUNG病 间质细胞 灌肠 

分 类 号：R726.5[医药卫生—儿科]