先天性巨结肠不同节段肠壁神经、平滑肌分布特征及临床价值研究  

Study on the Distribution and Clinical Value of Nerve and Smooth Muscle in Different Segments of Hirschsprung's Disease

作　　者：莫优炼 杨六成[2] 胡小华[1] 陈茂芳 段立锋[1] 苏嘉鸿 张平锋[1] 钟陈[1] 张家德[1] 冯大军[1] MO Youlian;YANG Liucheng;HU Xiaohua;CHEN Maofang;DUAN Lifeng;SU Jiahong;ZHANG Pingfeng;ZHONG Chen;ZHANG Jiade;FENG Dajun(Boai Hospital of Zhongshan,Southern Medical University,Zhongshan 528408,China)

机构地区：[1]南方医科大学附属中山市博爱医院,广东中山528408 [2]南方医科大学珠江医院

出　　处：《中国医学创新》2018年第9期1-4,共4页Medical Innovation of China

基　　金：广东省医学科学技术研究基金项目(A2017432)

摘　　要：目的:探究先天性巨结肠(HD)不同节段肠壁神经、平滑肌分布的特征,分析其临床价值。方法:选取2014年1月-2016年12月本院收治的手术切除的46例HD标本,设为观察组;选取本院同期收治的死于与胃肠道疾病无关的同年龄段的25例患儿的结肠标本,设为对照组。观察分析两组肠神经系统、平滑肌的分布情况。结果:观察组在除扩张段远端8 cm处以外的不同肠段的肠壁神经丛、神经节细胞计数均高于对照组(P<0.05)。观察组突触素(Syn)、神经节细胞黏附分子(NCAM)也均呈高表达,在扩张段远端8 cm处各指标虽均未达到正常标准,但与对照组比较,差异均无统计学意义(P>0.05)。观察组不同节段的环、纵肌层均有不同程度的增厚,在距扩张段远端8 cm处厚度均未恢复正常,与对照组比较,差异均有统计学意义(P<0.01)。两组环、纵肌层的空泡样变情况比较,差异均无统计学意义(P>0.05)。结论:HD在切除段的肠壁神经、平滑肌均有不同程度病变,但在距扩张段远端8 cm的位置肠壁神经、平滑肌病变得到缓解。手术切除范围可结合患儿自身情况,情况允许则可达或超过该区域。Objective:To explore the hirschsprung’s disease(HD)in different intestinal nerve and smooth muscle distribution characteristics,analysis of the clinical value.Method:46 HD specimens in our hospital from January 2014 to December 2016 were selected as the observation group;colonic specimens of 25 children of the same age who died of gastrointestinal diseases in the same period were selected as the control group.The distribution of nervous system and smooth muscle were observed and analyzed of the two groups.Result:The count of nerve plexus and ganglion cells in the intestinal wall of the observation group were higher than those of the control group in the different intestinal segments except the distal 8 cm of the dilated segment(P<0.05).The synaptophysin(Syn)and neural cell adhesion molecule(NCAM)in the observation group also showed high expression,in each index expansion section distal 8 cm although did not reach the normal level,but compared with the control group,there were no significant differences(P>0.05).In the observation group,the thickness of the ring and longitudinal muscles in different segments increased to varying degrees,and the thickness did not return to normal at 8 cm away from the distending part,the differences were statistically significant compared with the control group(P<0.01).There was no significant difference in vacuolar degeneration between the two groups(P>0.05).Conclusion:HD has varying degrees of pathological changes in the intestinal wall nerve and smooth muscle of the excised segment,but at the distance of 8 cm from the distally distended segment,the intestinal wall nerve is relieved.The range of surgical excision can be combined with the child’s own condition,and the condition is allowed to reach or exceed the area.

关 键 词：先天性巨结肠 平滑肌 神经节细胞 突触素 神经纤维 

分 类 号：R726.5[医药卫生—儿科]