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目的研究先天性肛门直肠畸形末端肠壁内神经系统发育情况,探讨术后排便功能障碍的病理机制。方法收集2001年1月至2005年12月先天性肛门直肠畸形结肠盲端标本76例(包括高位11例,中位26例,低位39例)。记录平均胎龄、出生体重及取得直肠标本时的年龄。采用免疫组织化学方法检测PGP9.5和S-100蛋白在上述标本中的表达水平。结果不同类型先天性肛门直肠畸形患儿出生时胎龄和平均体重比较无统计学意义。PGP9.5和S-100在高位畸形患儿中的表达明显低于中位畸形(高位vs中位,PGP9.5:0.422±0.008vs0.447±0.006,P值=0.0226;S-100:0.417±0.009vs0.442±0.007,P值=0.0401)和低位畸形(高位vs低位,PGP9.5:0.422±0.008vs0.450±0.009,P值=0.0331;S-100:0.417±0.009vs0.447±0.010,P值=0.0436);中位和低位畸形比较,差异无统计学意义(P>0.05);中位畸形一期手术组直肠末端PGP9.5和S-100的表达明显低于分期手术组(PGP9.5:0.421±0.010vs0.453±0.006,P值=0.0128;S-100:0.413±0.010vs0.449±0.006,P值=0.0048);低位畸形26例男性患儿取得直肠盲端标本时的平均年龄为(0.11±0.08)个月,13例女性患儿平均年龄为(6.15±0.29)个月(P<0.0001),但直肠末端PGP9.5和S-100的表达差异无统计学意义(P>0.05)。结论先天性肛门直肠畸形末端肠壁内神经系统的发育程度与畸形位置密切相关,这可能是高位畸形术后排便障碍的发生机制之一,中位畸形盲端肠壁内神经系统的发育可随年龄逐渐趋向于成熟。
Objective To study the development of the nervous system in the distal intestinal wall of congenital anorectal malformation and to explore the pathological mechanism of postoperative defecation dysfunction. Methods A total of 76 patients with congenital anorectal malformation (including 11 cases of high grade, 26 cases of median and 39 cases of low grade) were collected from January 2001 to December 2005. Record the average gestational age, birth weight and the age at which rectal specimens were obtained. Immunohistochemistry was used to detect the expression of PGP9.5 and S-100 protein in the above specimens. Results Different types of congenital anorectal malformations at birth gestational age and average body weight was not statistically significant. The expression of PGP9.5 and S-100 in children with high-level deformities was significantly lower than that of the median deformities (high vs mid PGP9.5: 0.422 ± 0.008 vs 0.447 ± 0.006, P = 0.0226; S-100: 0.417 ± 0.009 vs 0.442 ± 0.007, P = 0.0401) and low deformities (high vs low, PGP 9.5: 0.422 ± 0.008 vs 0.450 ± 0.009, P = 0.0331; S-100: 0.417 ± 0.009 vs 0.447 ± 0.010, P = 0.0436). There was no significant difference between the median and the lower deformities (P> 0.05). The expression of PGP9.5 and S-100 in the rectum at the stage of median deformity was significantly lower than that in the staged surgery group (PGP9.5: 0.421 ± 0.010vs0.453 ± 0.006, P = 0.0128; S-100: 0.413 ± 0.010vs0.449 ± 0.006, P = 0.0048) (0.11 ± 0.08) months. The average age of 13 women (6.15 ± 0.29) months (P <0.0001), but there was no significant difference in the expression of PGP9.5 and S-100 in the rectum Significance (P> 0.05). Conclusions The degree of development of the nervous system in the distal intestine wall of congenital anorectal malformations is closely related to the deformity location. This may be one of the mechanisms of postoperative defecation disorder after high malformations. The age tends to mature.