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Investigation on the Clinical and Pathology for Diagnosos Hirschs Prung and Allied HD

Author: YuanXiaoZuo
Tutor: TangXianMing
School: Guangxi Medical University
Course: Pediatric Surgery
Keywords: Hirschsprung With the edge of Hirschsprung disease Acetylcholinesterase Neuron-specific enolase Immunohistochemistry
CLC: R726.5
Type: Master's thesis
Year: 2011
Downloads: 55
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Abstract

Objective: In this study, a retrospective study by the megacolon radical postoperative recurrence proximal resection margin pathological, S-100 and NSE immunohistochemical staining observed nerve fibers and ganglion cell morphology and count, congenital homologous disease megacolon (Hirschsprung's disease, HD) and megacolon (Hirschsprung's disease allied disease, HAD) clinical and pathological morphological characteristics and surgical cause of relapse. Explore the intraoperative frozen AChE dyeing and NSE immunohistochemistry of joint the megacolon and homologous disease surgery, diagnostic accuracy, in order to guide the surgical resection of the bowel range. Methods: The first part: Collect April 2003 - March 2010 preoperative diagnosis of HD and HAD line megacolon radical mastectomy patients, patients with tissue sections and then due to constipation relapse admission, a total of 33 cases and take the proximal resection margin organization of the wax block, since on the cutting edge of the cutting edge to the next serial sections 5 to 7 as the experimental group; another 30 cases of megacolon and homologous disease bowel resection specimens as normal control group, two groups of slicing line NSE, S -100 immunohistochemical staining to judge and counting ganglion cells and nerve fibers. Nine cases of these 33 patients relapsed patients readmission line the proximal end of the secondary megacolon radical mastectomy specimens and cutting edge for slicing line NSE, S-100 immune staining judge their nerve fibers and ganglion cells, and to assess the morphology of the cutting edge. Part II: collected from November 2009 to November 2010 Clinical manifestations of chronic constipation and bloating, barium enema to be diagnostic for HD and had surgery in children of the 74 cases, surgery Bank of China Ache, NSE joint stained diagnosis of HD and HAD as the experimental group, with the the specimen the Pathological return results diagnostic for HD and HAD as the control group, the diagnostic accuracy of compare intraoperative joint. Results: 33 patients with preoperative diagnosis of HD and HAD underwent surgery and postoperative constipation recurrence of hospitalized patients with lesions end and proximal resection margin tissue sections, the use of S-100, NSE carried staining, diagnosis HD merge IND -B 10 HD combined the ganglion cells thrombocytopenia 6, HD merge immature ganglion cells in 5 cases, IND-B 6 cases, the ganglion cells thrombocytopenia 5 cases, neuronal dysplasia HD merge IND-B type and IND-B-type proximal ganglion cell density and intestinal myenteric plexus density increased significantly, with the normal group, the difference was statistically significant (P lt; micro-meter count; 0.01); the HD combined the ganglion cells thrombocytopenia proximal bowel plexus ganglion cell density and muscle density was significantly reduced compared with the normal group, the difference was statistically significant (P lt; 0.01), HD combined ganglion cells immature disease and ganglion cells, immature disease proximal intestine ganglion cell density and myenteric plexus density is similar to the normal bowel, the difference was not statistically significant (P gt; 0.05) The 33 specimens, S-100, NSE staining results showed that nine cases of normal cutting edge, were followed up for 8 patients with normal bowel function, no significant complications; 1 cases IND-B still constipation symptoms compared with the preoperative has been reduced; 24 patients after conservative treatment and one was lost to follow-up, 10 cases of normal bowel function; 13 patients with symptoms of constipation by laxatives, stool softener ease. Treatment effect differences by comparing the secondary surgery group and the conservative treatment group was statistically significant (P lt; 0.05) the second surgery group than in the conservative treatment group treatment effect, indicating the scope of bowel resection and postoperative treatment effect related. Review clinical history statistics, of megacolon and homologous disease patients a total of 74 cases of surgical patients aged 6 months to 1 year old up to. The male to female ratio is 6:1, and the diagnosis of HAD to female ratio was 3:1. Cholinesterase staining and NSE immunohistochemical staining of the 74 patients in the surgery were done, the results showed: 74 patients, 54 cases of HD (54/74), with the results of the final return of the Department of Pathology (58 / 74) compared to the difference was not statistically significant (p = 0.388); 12 cases of HAD (12/74), the last return Pathology (15/74) compared to no significant difference (p = 0.75) . Conclusion: The retrospective data immunohistochemical method and results showed that patients with Hirschsprung's disease recurrence after analysis of micro-meter confirmed by pathology megacolon homologous disease persists exception because of its cutting edge one of the main lead to recurrence, surgery combined with cholinesterase staining and NSE immunohistochemical staining can assist in the differential diagnosis of HD and HAD.

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