Rintala R, Lindahl H, Sariola H, Rapola J, Louhimo I
Children's Hospital, University of Helsinki, Finland.
J Pediatr Surg. 1990 Jun;25(6):665-8. doi: 10.1016/0022-3468(90)90358-g.
Histological investigation of the rectal blind pouch and rectourogenital or rectoperineal connection was performed in 10 patients with high or intermediate anorectal malformations. Nine of the patients underwent postoperative manometric evaluation. In nine of the 10 patients, transitional epithelium typical of the normal anal canal could be found in the distal rectum or rectal end of the fistulous connection. The zone of transitional epithelium was aganglionic and showed abnormally strong acetylcholinesterase reaction. A positive rectoanal inhibitory reflex was found manometrically in all cases in which the distal rectal pouch was utilized in the reconstruction of the anal canal. The slow pressure wave activity of the reconstructed anal canal was characteristic of a normal anal canal. The manometric evidence strongly suggests that there is a functional internal sphincter in high and intermediate anorectal malformations. The present study shows that in anorectal malformations the distal rectal pouch with the fistulous connection is actually an ectopic anal canal.
对10例高位或中位肛门直肠畸形患者的直肠盲袋及直肠泌尿生殖或直肠会阴连接部进行了组织学研究。其中9例患者术后接受了测压评估。10例患者中有9例，在远端直肠或瘘管连接的直肠末端可发现正常肛管典型的移行上皮。移行上皮区无神经节，且乙酰胆碱酯酶反应异常强烈。在所有利用远端直肠盲袋重建肛管的病例中，通过测压均发现了阳性的直肠肛门抑制反射。重建肛管的缓慢压力波活动是正常肛管的特征。测压证据有力地表明，高位和中位肛门直肠畸形存在功能性内括约肌。本研究表明，在肛门直肠畸形中，带有瘘管连接的远端直肠盲袋实际上是异位肛管。
