先天性小肠闭锁术后肠功能不良的病理学基础

The Pathological Basis of Intestine Malfunction after Operation of Congenital Intestinal Atresia

目的:探讨先天性小肠闭锁术后肠道功能不良的原因。方法:应用免疫组化技术检测13例先天性小肠闭锁患儿肠壁内亲神经营养因子3(neurotrophin3,NT-3)、神经生长因子高亲和力受体C(Trk-C)、神经元纤维酸性蛋白(glialfibrillaryacidprotein,GFAP)、神经丝蛋白(neurofilament,Nf)和c-kit抗体(c-kit)的表达情况。并以正常小肠的标本作对照。结果:c-kit、NT-3、Trk-C和Nf在对照组中的表达高于闭锁组;GFAP在闭锁组的胶质细胞中表达明显增高;在闭锁组可见Cajal细胞、神经节细胞减少,神经干变细,分段切片,距盲端8cm神经节细胞分布接近正常,11cm处Cajal细胞分布接近正常。结论:小肠闭锁的近端肠壁内Cajal细胞、神经节细胞的减少和神经干的变细可以影响闭锁区域肠道的功能,是影响患者术后肠道功能不良的原因所在。

Objective： To evaluate the pathological reason of intestine malfunctions after operation of congenital atresia and discuss its clinical significance. Methods： Immunohistochemical stainings for antibody c-kit, Neurtrophin-3 （NT-3）, tyrosine kinase-C（Trk-C）, glial fibrillary acidic protein （GFAP） and neurofilament （Nf） were performed on small intestine in patients with congenital intestinal atresia （n=13） with comparison of normal intestine. Results： The expressions of NT-3, Trk-C and Nf were significantly lower in intestinal atresia group than that of normal intestine, however, the expression of GFAP was higher in intestinal atresia group compared to that of the normal group. The expressions of NT-3 and Trk-C were normal at the site of 8 cm away from the blind-ending. Cajal cells were also expressed normally at 11 cm from the blind-ending. Conclusion＂ The intestine malfunction after operation may due to the loss of Cajals, anglia and axonal injury in the myenteric plexus.