还原型烟酰胺腺嘌呤二核苷酸脱氢酶染色法术中快速诊断婴幼儿先天性巨结肠的价值  

Value of nicotinamide adenine dinuleotide phosphate diaphorase staining in the intraoperative rapid pathological diagnosis of congenital megacolon in infants

作　　者：赵淑君 李鸿岩 阿米娜.哈山 ZHAO Shu-jun;LI Hong-yan;AMINA Ha-shan(Department of Pathology,the First People′s Hospital of Urumqi City,Urumqi 830011,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]乌鲁木齐市第一人民医院病理科,新疆乌鲁木齐830011

出　　处：《新乡医学院学报》2018年第4期294-297,共4页Journal of Xinxiang Medical University

基　　金：乌鲁木齐市卫生局科技计划项目(编号:201434)

摘　　要：目的探讨还原型烟酰胺腺嘌呤二核苷酸脱氢酶(NADPH-d)酶组织化学染色法在术中快速诊断婴幼儿先天性巨结肠的价值。方法选取2015年1月至2017年3月新疆乌鲁木齐儿童医院收治的37例先天性巨结肠患儿术中切除的肠管为观察标本,以同期因坏死性小肠结肠炎行结肠造瘘术患儿的切除肠管标本作为实验对照,将先天性巨结肠患儿的肠管标本分为扩张段和痉挛段,进行常规冰冻连续切片,采用NADPH-d进行染色(NADPH-染色组),显微镜下观察神经丛及神经节细胞的染色情况,并与术中快速苏木精-伊红(HE)染色法(HE染色组)进行配对比较。结果 37例患儿中,NADPH-d染色诊断阳性36例(97.3%),阴性6例(2.7%);HE染色诊断阳性34例(91.9%),阴性3例(8.1%);2种染色方法均诊断阳性或阴性者分别为34例、1例,另2例NADPH-d染色诊断阳性者HE染色诊断为阴性;2种染色方法的诊断结果比较差异无统计学意义(χ~2=0.059,P>0.05)。NADPH-d染色组扩张段标本低倍镜下可见呈串珠状分布的神经丛样结构,高倍镜下可见细胞质着紫蓝色、细胞核空白无着色的细胞,HE复染显示串珠状分布的紫蓝色组织为肌间神经丛,黏膜下未见着紫蓝色的神经丛;高倍镜下可清楚分辨核大、深染、细胞质略呈蓝色的神经节细胞。NADPH-d染色组痉挛段标本镜下背景清晰,无任何着色,未见神经丛及神经节细胞。HE染色组扩张段标本肌间神经丛内隐约可见神经节细胞,痉挛段肌间及黏膜下可见分布杂乱的神经丛,其间无神经节细胞。结论 NADPH-d染色法诊断婴幼儿先天性巨结肠快速、精确、易操作,NADPH-d法与术中快速HE染色法联用能提高诊断效率,准确判断病变段肠管的切除范围。Objective To investigate the value of nicotinamide adenine dinuleotide phosphate diaphorase(NADPH-d histochemical staining in the intraoperative rapid pathological diagnosis of congenital megacolon in infants.Methods The intestinal specimens of 37 infants with congenital megacolon were selected from January 2015 to 2017 in the Children′s Hospital of Urumqi City.The intestinal specimens of infants with necrotizing enterocolitis underwent colostomy in the same period were selected as experimental controls.The specimens of congenital megacolon were divided into dilated segments and spasmodic segments,and routine frozen section was performed with NADPH-d staining(NADPH-d staining group),and the staining results of the nerve plexus and ganglion cells were observed under the microscope,the results were compared with the rapid HE staining(HE staining group).Results In the 37 infants,the NADPH-d staining was positive in 36 cases(97.3%),and it was negative in 6 cases(2.7%);The HE staining was positive in 34 cases(91.9%),and it was negative in 3 cases(8.1%).The results of the two staining methods were all positive or negative in 34 cases and 1 case,respectively.The other two cases with positive NADPH-d staining were negative with HE staining.There was no significant difference in the diagnostic results between the two staining methods(χ2=0.059,P>0.05).The nerve plexus structure of beaded distribution was found under low magnification in the dilated segment specimens in NADPH-d staining group,and the cells with purplish blue in cytoplasm and no staining in nucleus were found under high magnification.HE staining showed that the beaded hyacinthine tissues were myenteric nerve plexus,and no hyacinthine nerve plexus was found in the submucosa;the ganglion cells with large nucleus,deep dyed and blue cytoplasm could be clearly identified at high magnification.The NADPH-d staining showed the clear background,no coloring,no nerve plexus and ganglion cells in the congenital megacolon of spasmodic segments.HE staining showed that

关 键 词：先天性巨结肠 快速病理诊断 婴幼儿 还原型烟酰胺腺嘌呤二核苷酸脱氢酶染色 苏木精-伊红染色 

分 类 号：R726.5[医药卫生—儿科]