慢传输型便秘结肠肌间神经丛形态学改变及其临床意义

MORPHOLOGICAL CHANGES AND SIGNIFICANCE OF COLONIC MYENTERIC PLEXUS IN PATIENTS WITH SLOW TRANSIT CONSTIPATION

目的:探讨慢传输型便秘(STC)结肠传输缓慢的神经病理学基础。方法:对14例STC患者的乙状结肠全层组织进行常规HE染色、肌间神经丛Holmes银浸染色以及S-100蛋白免疫组化染色等研究。并与11例非梗阻性直肠癌患者的正常乙状结肠标本作对照。结果:14例STC患者乙状结肠肌间神经丛嗜银性反应较对照组均有不同程度的降低,神经纤维排列紊乱并有缠结现象。肌间神经丛内S-100蛋白的免疫反应性在STC组较对照组明显增强(P<0.01)。结论:STC患者结肠肌间神经丛有明显的病理学变化,它是STC患者结肠传输缓慢的神经病理学基础。这种改变可能与长期服用接触性泻剂有关,但其具体因果机制尚待进一步研究。

To investigate the neuropathologic changes of colonic myenteric plexus in patients with slow tansit constipation (STC) . Methods: Fourteen patients (1 man and 13 women, mean age, 44 years, ranging from 26-68 years) with STC underwent a partial or total colec-tomy. All resected sigmoid colon specimens were investigated with conventional microscope by way of hematoxylin and eosin stains, Holmes's silver stains and immunohistochemical investigation with the antibody against S-100 protein. Eleven normal sigmoid specimens from the patients with nonobstructed rectal adenocarcinoma were also studied as controls. Results: Silver stains of the myenteric plexus showed quantitative reduction in argyrophilic neurons in varying degree in all of the 14 patients in contrast to the controls. S-100 protein demonstrated an increase in proportion of neural tissue in the myenteric plexus in STC group contrasted with the controls ( P< 0. 01). Conclusion: Distinctive abnormalities of colonic myenteric plexus in the patients with STC were demonstrated. It is probably associated with constant abusion of laxatives.