痔核上方直肠壁组织形态学研究

Study on the tectology change of rectum wall above the hemorrhoids

目的探讨痔核上方直肠黏膜下组织中是否存在病理改变及其形态特征和临床意义。方法利用特殊染色和免疫组织化学染色技术（Elivision两步法），对比研究21例Ⅲ～Ⅳ度内痔患者的痔上黏膜环切术标本（包括痔上远和近端）直肠黏膜下组织中平滑肌和Ⅲ型胶原纤维，并以7例（非痔）直肠上段癌患者肛垫上方组织作为对照，观察其形态改变特征。结果肛垫（痔核）上方直肠黏膜肌层和血管壁平滑肌纤维断裂、松散、走行紊乱，其近端直肠壁平滑肌改变与更远端直肠壁组织以及非痔患者相对正常肛垫上方组织比较具有统计学意义（P〈0．05）。痔核上方直肠黏膜下组织中Ⅲ型胶原纤维增生，并取代平滑肌纤维。结论痔的病理改变范围超过了肛垫自身，痔核上方的直肠黏膜下组织中平滑肌松散、断裂及被增生的Ⅲ型胶原纤维增生所取代。

Objective To investigate the histomorphological characteristics and its significance of rectum wall above hemorrhoids. Methods Tissues of rectum wall above hemorrhoids were obtained after stapled hemorrhoidopexy from 21 patients with grade Ⅲ-Ⅳ internal hemorrhoids. Seven macroscopically normal rectal tissues collected from upper rectal cancer patients without a history of hemorrhoids served as control. Masson trichrome staining was performed for detecting smooth muscles and collagen in the tissues. The expression of type Ⅲ collagen was detected by using immunohistochemical staining in the two groups. Results Morphological abnormalities, such as fragment, rupture, disorganization were found in smooth muscle of proximal rectal tissues above the piles, and it was statistically different from the distal rectal tissues above the piles and control tissues （ all P 〈 0. 05 ）. Moreover, hyperplasia of type Ⅲ collagen in both muscularis mucosa and rectum wall in tissues above hemorrhoids were observed, no such changes was found in the control tissues. Conclusions The range of pathological changes in hemorrhoids is beyond the anal cushions. The pathological changes of the smooth muscle and the type Ⅲ collagen in the tissues above the piles are the pathological basis of hemorrhoids.