快速乳酸脱氢酶染色在先天性巨结肠及肠神经元发育异常术中诊断的应用  

Application of Rapid Lactate-Dehydrogenase Staining on Intraoperative Diagnosis of Hirschsprung's Disease and Intestinal Neuronal Dysplasia

作　　者：向磊[1] 柴成伟[1] 吴晓娟[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：《实用儿科临床杂志》2009年第3期227-229,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨快速乳酸脱氢酶(LDH)染色在术中诊断先天性巨结肠(HD)及肠神经元发育异常(IND)的可行性及临床意义。方法20例术前诊断为HD或巨结肠同源病(HAD)患儿术中分别在直肠及近端结肠取全层标本行快速LDH染色,通过预热孵育液和提高氧化型辅酶Ⅰ(NAD)水平将反应时间缩短在20min内,同时行快速乙酰胆碱酯酶(AChE)染色,并与术后病检结果进行Kappa诊断一致性检验。结果LDH染色孵育20min后出现蓝紫色沉淀,可识别为神经节细胞,增加染色时间并不增加强染色程度;20例患儿中HD8例,IND6例,HD并IND3例,均与术后病理检查结果相一致;1例直肠LDH染色有少量表达阳性,但AChE染色阳性,术后病检为神经节细胞减少症;2例直肠LDH和AChE染色均阴性,术后病检为HD、神经节细胞减少各1例。Kappa检验HD、IND、HD并IND的患儿检验结果与术后病理检查结果有较强的吻合性(K≥0.7)。结论快速LDH染色联合快速AChE染色术中诊断HD和IND结果可靠,可帮助术中判断病变肠管的范围。Objective To explore the feasibility and clinical significance of rapid lactate -dehydmgenase（LDH） staining method on intraoperative diagnosis of Hirschsprung＇s disease （HD） and intestinal neuronal dysplasia （IND）. Methods Twenty children with suspected HD or Hirschsprung＇s allied disease （HAD） underwent intraoperative full -thickness intestinal biopsies. An improved rapid LDH staining method was used, by pre -heat of the staining reagent and increase of the content of β -nicotinamide adenine dinucleotide hydrate （NAD）, the incubation time was controlled within 20 minutes. The tissues were also examined with rapid acetyleholinesterase （ACHE） staining method. The staining results were compared with postoperative pathological analysis by Kappa diagnosis concordance test. Results After an incubation time of 20 minutes by using this improved rapid LDH staining method, ganglionic cells with blue purple precipitation could be clearly demonstrated, the staining degree did not deepen when extension of the incubation time. In all 20 children, 8 eases were HD,6 cases were IND,3 eases were mixed HD/IND, all experimental results were consistent with postoperative pathological diagnosis; There was a little positive coloration in 1 case of rectum LDH staining method but positive in AChE staining method, the case was immaturity of ganglion cells. Two cases which were negative both in LDH staining method and AChE staining method were diagnosised as HD and hypoganglionosis by pathological diagnosis. The experimental results and postoperative pathological diagnosis in HD, IND, HD/IND children were highly consistent by Kappa diagnosis concordance test（K≥0.7）. Conclusions The rapid LDH staining method can offer quick and reliable evidences for diagnosising HD and IND, and give help to accurately evaluate the range of the affected bowel segment during operation.

关 键 词：先天性巨结肠 肠神经发育不良 乳酸脱氢酶 术中诊断 

分 类 号：R726.5[医药卫生—儿科]