先天性肠闭锁Cajal间质细胞和突触素的研究

A study on the interstitial cells of Cajal and synaptophysin in patients with congenital intestinal atresia

目的探讨Cajal间质细胞(ICCs)和突触素与肠闭锁手术、术后肠动力障碍的关系。方法采用Envision法免疫组织化学技术，对30例先天性肠闭锁(IA)盲端近端和远端肠标本及4例正常对照标本，分别观察ICCs和突触的形成情况。结果在IA组，ICCs和突触素在盲端近、远端的分布与正常对照组相比显著减少，ICCs网络被破坏。近端改变范围在8cm左右，远端改变局限在1～2cm，且随着远离闭锁盲端，上述指标有增加趋势。在对照组，ICCs大量分布于肠肌丛，并相互联接形成网络，肌间神经丛可见大量突触素表达。结论先天性肠闭锁盲端近端和远端肠管有ICCs分布和突触形成的异常，手术中要尽量切除病变肠管，以免造成术后肠功能障碍。

Objective To examin alterations of interstitial cells of Cajal(ICCs) and synaptophysin in dilated proximal and distal segments of the intestines from patients with congenital intestinal atresia(IA).Methods The distribution of ICCs and synaptophysin were examined by envision immunohistochemistry with mouse antihuman monoclonal c-kit antibody and rabbit antihuman monoclonal synaptophysin antibody in 30 IA cases(group IA)IA and 4 normal controls(group C)(2 neonates and 2 adults).Results In group IA,the number of c-kit cells and synaptophysin were markedly less than those in group C predominantly in the proximal segment,and the network was destroyed.The changes extended about 8cm in the proximal segment and 1～2cm in the distal,which showed a tendency of increase at the farther of the atresia.In group C,a great number of c-kit positives cells was found in the myenteric plexuses with a tendency of network formation,and abundant synaptophysin expressions in the myenteric plexuses.Conclusion A hypoplasia of c-kit positive cells and synaptophysin was seen predominantly in the proximal segments of IA,which may contribute to the postoperative intestinal dysmotility in IA case,suggesting that the abnomal intestine should be resected as far as possible.