Chadha Rajiv, Agarwal Kiran, Choudhury S Roy, Debnath Pinaki Ranjan
Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
J Pediatr Surg. 2008 Nov;43(11):2048-52. doi: 10.1016/j.jpedsurg.2008.05.021.
The aim of this study was to perform a detailed histopathologic examination of the terminal colonic pouch and the colovesical fistula (CVF) excised during surgical management of male patients with the more severe forms (types I/II) of congenital pouch colon (CPC) associated with anorectal agenesis.
From January 2005 to December 2006, 25 male patients with types I/II CPC underwent abdominal exploration with dissection of the terminal portion of the colonic pouch and associated CVF till the bladder, division-ligation of the fistula, and excision of the colonic pouch. In 6 of the 25 patients, a complete dissection of the fistula to the bladder was possible, and in them, the terminal portion of the colonic pouch and the CVF were subjected to detailed histopathologic examination. The 6 patients included 3 newborns in whom this surgery was performed as a primary procedure, and 3 patients aged 3 months, 15 months, and 2 years, respectively, in whom a window colostomy of the pouch had earlier been performed. After due processing, multiple sections from the specimens were stained using the routine H&E method and examined under the microscope under different magnifications.
In 4 specimens, the epithelial lining of the CVF consisted of transitional stratified epithelium with underlying anal/urethral glands. In 2 specimens, obtained from patients 15 months and 2 years old, respectively, the lining was of nonkeratinizing, stratified squamous epithelium. Other findings included aganglionosis in the muscle layers (n = 2), submucosal and subserosal fibrosis (n = 1), and thickening of muscle layers in the fistulous portion, suggestive of the presence of an internal sphincter (n = 2).
The CVF in patients with types I/II CPC shows histologic features of the normal anorectal canal.
本研究旨在对患有与肛门直肠闭锁相关的更严重类型（I/II型）先天性袋状结肠（CPC）的男性患者手术治疗期间切除的末端结肠袋和结肠膀胱瘘（CVF）进行详细的组织病理学检查。
2005年1月至2006年12月，25例I/II型CPC男性患者接受了腹部探查，解剖结肠袋末端及相关的CVF直至膀胱，瘘管离断结扎，并切除结肠袋。25例患者中有6例可将瘘管完整解剖至膀胱，对这6例患者的结肠袋末端和CVF进行了详细的组织病理学检查。这6例患者包括3例新生儿，该手术作为一期手术进行，另外3例患者年龄分别为3个月、15个月和2岁，此前已对袋状结肠进行了造瘘术。标本经过适当处理后，用常规苏木精-伊红（H&E）方法对多个切片进行染色，并在不同放大倍数下在显微镜下检查。
在4个标本中，CVF的上皮内衬由移行复层上皮和其下方的肛门/尿道腺组成。在分别取自15个月和2岁患者的2个标本中，内衬为非角化复层鳞状上皮。其他发现包括肌层无神经节细胞症（n = 2）、黏膜下和浆膜下纤维化（n = 1）以及瘘管部分肌层增厚，提示存在内括约肌（n = 2）。
I/II型CPC患者的CVF显示出正常肛管的组织学特征。
