神经源性大便失禁患儿提肛肌的病理学改变及临床意义

Pathological changes of levator ani in children with neurogenic fecal incontinence and its' clinical significance

目的 对神经源性大便失禁患儿的提肛肌进行病理学观察,为临床治疗提供病理学依据。方法 取22例神经源性大便失禁患儿的提肛肌标本,男15例,女7例,平均8.2岁。另取8例排便正常儿童的提肛肌作为对照,男5例,女3例,平均8岁。采用免疫组化染色(SY、NF200和MBP)进行观察分析。结果 对照组所有提肛肌标本NF-200和MBP均强阳性反应(染色强度++～+++),SY染色深且数目多。神经源性大便失禁患儿组,SY染色浅,小且数目少,NF-200和MBP染色强度均较弱(-～+),与正常对照组比较明显减少,但脊髓脊膜膨出术后组和隐性脊柱裂患儿组之间SY、NF-200和MBP指标无明显差异。结论 提肛肌神经支配异常是造成提肛肌功能不全的病因,为临床上采用盆底功能锻炼、生物反馈和手术等方法恢复提肛肌肌肉功能来治疗神经源性大便失禁提供了病理学依据。

Objective To observe histological changes of levator ani using immunohistochemical methods so as to provide a pathologic evidence in clinical treatment. Methods Levator ani specimens were got from 22 patients (7 girls and 15 boys) with neurogenic fecal incontinence and 8 cases (3 girls and 5 boys) with normal fecal continence during operations. Immunohistochemical methods using antibody against SY、NF200 and MBP were performed to observe histological changes on levator ani. Results Neuromuscu- lar junctions of levator ani were significantly diminished and there were less staining of NF200 and MBP in children with neurogenic fecal incontinence as compared with the normal group. Conclusions Decreasing of innervation of levator ani might be responsible for dysfunction of levator ani in children with neurogenic fe- cal incontinence. Strengthening pelvic floor by levator ani functional excises or biofeedback or muscle re- placement might be needed in those patients.