Gangopadhyay A N, Upadhyaya Vijai D, Gupta D K, Agarwal D K, Sharma S P, Arya N C
Department of Paediatric Surgery Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Asian J Surg. 2008 Oct;31(4):211-5. doi: 10.1016/S1015-9584(08)60089-5.
Until recently, surgeons have been posed with a dilemma---whether or not they should preserve the terminal end of the distal rectal pouch and the fistula region in anorectal malformations (ARMs). A detailed histological study of this region was conducted to establish a consensus for preserving or excising this region for reconstruction of ARMs.
Histopathological examination using haematoxylin and eosin-stained sections of the terminal portion of the distal rectal pouch and proximal portion of the rectourogenital or rectoperineal connection was performed in 60 cases of high, intermediate and low ARMs.
Distorted internal sphincter was present in 93.3% of high, 90% of intermediate and 100% of low ARMs. The proximal fistula region was lined by transitional epithelium in 50% of cases, and anal glands were present in 83.3% and anal crypts in 68.3% of cases. The rectal pouch in the region of the internal sphincter and fistula was aganglionic in all cases.
This study shows that the terminal end of the distal rectal pouch and proximal fistula region possess distorted anal features with aganglionosis, and contradicts the recommendation that this region should be reconstructed in patients with malformations.
直到最近，外科医生一直面临一个两难境地——在肛门直肠畸形（ARMs）中，他们是否应该保留直肠远端袋状结构的末端和瘘管区域。对该区域进行了详细的组织学研究，以就保留或切除该区域用于ARMs重建达成共识。
对60例高、中、低位ARMs患者，使用苏木精和伊红染色切片对直肠远端袋状结构末端和直肠泌尿或直肠会阴连接近端进行组织病理学检查。
93.3%的高位ARM患者、90%的中位ARM患者和100%的低位ARM患者存在内括约肌扭曲。50%的病例近端瘘管区域内衬移行上皮，83.3%的病例存在肛门腺，68.3%的病例存在肛门隐窝。所有病例中内括约肌和瘘管区域的直肠袋状结构均无神经节。
本研究表明，直肠远端袋状结构末端和近端瘘管区域具有扭曲的肛门特征且无神经节，这与畸形患者应重建该区域的建议相矛盾。
