无肛畸形儿直肠盲端肠壁内肾上腺素能神经的改变

Changes of Adren ergic Innervation of the Rectal Pouch in Anorectal Malformation

目的通过对正常儿童及无肛畸形儿童直肠远端肠壁内肾上腺素能神经的观察探讨无肛畸形儿童的病理改变。方法采用蔗糖-磷酸二氢钾溶液加乙醛酸(SPG)法诱发荧光,对7例正常儿和5例不同畸形类型的无肛畸形儿直肠远端后壁进行观察。结果正常儿直肠远端后壁各层均见有不同强度的肾上腺素能神经纤维,粘膜下层有呈黄绿色较耀眼的荧光纤维,肌层内可见荧光纤维沿肌纤维的走行方向分布,呈网蓝状结构。肠壁内神经丛中,神经节细胞不显示荧光,在神经节中只能看到呈卵圆形的无荧光暗区。而无肛畸形儿直肠盲端后壁内肾上腺素能神经纤维的形态、分布大致与正常儿相同,肌间显示荧光的纤维较正常儿减少,荧光强度减弱,较少看到耀眼的荧光纤维。结论无肛畸形儿直肠盲端肠壁内肾上腺素能神经纤维的数量较正常儿明显减少和荧光强度减弱,并且畸形位置越高,上述改变越明显。该改变可能是无肛畸形的病理改变之一。

Objectives To obser ve the distribution of the adrenergic nerves in the rectal pouch of anorectal malf ormation.Methods Sucrose-potassium dihydrogen phosphate plus glyoxylic acid i nduced-fluorescence was used to visualize the adrenergic nerves in7normal dist al rectum samples and5rectal pouch of anorectal malformation.Results different intensities of adrenergic nerve fibers were seen in each layer of normal rectu m,and there were yellowish-green dazzling fluorescent fibers in the submucosa l layer.In the muscle layer,fluorescent fibers run along the muscle fibers an d interlaced into irregular network.Ganglia in intramural plexus showed oval da rk region instead of fluorescence.The form and distribution of adrenergic nerve fibers in the rectal pouch of anorectal malformation were similar to that of no rmal,but intramuscular fluorescent fibers were a few and intensity decreased ,illuminated fluorescent fibers was seen hardly.Conclusions The number and i ntensity of fluorescent muscle fibers in rectal pouch of children with anorec-talmalformation were all decreased than that in normal children,and the changes were more evident in high anom alies，w hich m ight be one of the pathologic changes of anorectal m alform ation．