巨结肠扩张段cad和s-100检测与预后关系的分析-analysis of the relationship between the prognosis and the detection of cad and s - 100 in the expanded colon.docxVIP

巨结肠扩张段 CAD 和 S-100 检测与预后关系的研究中文摘要目的探讨先天性巨结肠（HD）扩张段切缘神经节细胞组织蛋白酶 D（CAD） 及 S-100 蛋白免疫组化测定与预后的关系。方法 对近十年在我院行经肛巨结肠根治术的 111 例病例进行随访，从获得随 访的 74 例中选取 32 例进行分组。其中男 20 例，女 12 例。年龄最小者 44 天,最大7 岁。32 例术前均经钡剂灌肠造影及肛管测压检查明确诊断,术后经病理证实为 HD。有症状组（A 组）22 例，术后反复出现腹泻、腹胀、便秘、发热肠炎、梗阻 等症状，常需灌肠、抗生素补液治疗。无症状组（B 组）10 例，术后大便很快可 正常自解，无肠炎、便秘等发生。另从行横结肠或乙状结肠造瘘术且进行病理检 查的患儿中选取 5 例，其病理可见发育成熟的神经节细胞，作为正常对照组（C 组）。对三组病例病理标本神经节细胞进行 CAD 及 S-100 免疫组化测定，观察 A、 B 组狭窄段和扩张段肠壁及 C 组肠壁神经组织中 CAD 及 S-100 的表达特点,综合术 后随访情况加以分析。结果 A 组扩张段肠壁神经丛内 CAD 对神经节细胞多数呈弱阳性染色，少数 表达为阳性、阴性；B 组扩张段及 C 组肠壁肌间与黏膜下层神经丛中多数可见 CAD 阳性染色的神经节细胞，个别弱阳性。A 组大部分病例扩张段 S-100 染色可见到数 量较少的细胞状“空白区”，肠壁各层都可见 S-100 强阳性的神经纤维束；B 组 扩张段和 C 组肠壁神经丛内可见正常分布的细胞状“空白区”。A、B 两组扩张段 近侧切缘 CAD 和 S-100 的表达差异有统计学意义。结论CAD 和 S-100 是肠神经节细胞特异性较高的标志物,可作为判断 HD 神经发育的重要手段。对扩张段近端肠壁联合检测 CAD 和 S-100，判定神经节细胞和神经纤维的表达，将有助于指导临床手术确定扩张段切除界限，从而减少术后 肠炎、便秘等并发症。关键词先天性巨结肠；病理学；免疫组化测定；外科学Research of CAD and S-100 Protein in Prognosis of Hirschsprung’s DiseaseAbstractObjective To investigate the clinical significance of CAD and S-100 Protein in the wall of colon in Hir schsprung s Disease.Methods 111 cases with common type HD were followed-up after trans-anal One~stage Soave pull through operation(74 cases were followed). 32 cases(male 20， female 12) were grouped which the youngest was forty-four days old and the maximumwas seven years old. They were diagnosed by barium enema, anorectal manometry etc before surgery and Confirmed by pathological examination after surgery. The main symptoms of symptomatic group (group A,n=22) were diarrhea, abdominal distention,constipation, enteritis, fever, intestinal obstruction which often needed the treatment of coloclysis ,and anti-inflammatory, etc while asymptomatic group (group B,n=10) did not show these conditions, 5 cases were chosen as the normal control group(group C, n=5) from the operation of transverse colon or sigmoid colon stoma which had mature ganglion cell in the intestinal wall. Combined with the morphological character of the gangliocyte in the intesti