Song Eun Mi, Kim Jong Wook, Lee Sun-Ho, Chang Kiju, Hwang Sung Wook, Park Sang Hyoung, Yang Dong-Hoon, Jung Kee Wook, Ye Byong Duk, Byeon Jeong-Sik, Yang Suk-Kyun, Lee Hyo Jeong, Yu Chang Sik, Kim Chan Wook, Park Seong Ho, Kim Jihun, Myung Seung-Jae
Departments of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-do, Korea.
J Neurogastroenterol Motil. 2019 Jan 31;25(1):137-147. doi: 10.5056/jnm18121.
BACKGROUND/AIMS: Previous studies from Korea have described chronic intestinal pseudo-obstruction (CIPO) patients with transition zone (TZ) in the colon. In this study, we evaluated the pathological characteristics and their association with long-term outcomes in Korean colonic pseudo-obstruction (CPO) patients with TZ.
We enrolled 39 CPO patients who were refractory to medical treatment and underwent colectomy between November 1989 and April 2016 (median age at symptoms onset: 45 [interquartile range, 29-57] years, males 46.2%). The TZ was defined as a colonic segment connecting a proximally dilated and distally non-dilated segment. Detailed pathologic analysis was performed.
Among the 39 patients, 37 (94.9%) presented with TZ and 2 (5.1%) showed no definitive TZ. Median ganglion cell density in the TZ adjusted for the colonic circumference was significantly decreased compared to that in proximal dilated and distal non-dilated segments in TZ (+) patients (9.2 vs 254.3 and 150.5, ＜ 0.001). Among the TZ (+) patients, 6 showed additional pathologic findings including eosinophilic ganglionitis (n = 2), ulcers with combined cytomegalovirus infection (n = 2), diffuse ischemic changes (n = 1), and heterotropic myenteric plexus (n = 1). During follow-up (median, 61 months), 32 (82.1%) TZ (+) patients recovered without symptom recurrence after surgery. The presence of pathological features other than hypoganglionosis was an independent predictor of symptom recurrence after surgery ( = 0.046).
Hypoganglionosis can be identified in the TZ of most Korean CPO patients. Detection of other pathological features in addition to TZ-associated hypoganglionosis was associated with poor post-operative outcomes.
背景/目的：韩国以往的研究描述了结肠存在过渡区（TZ）的慢性肠假性梗阻（CIPO）患者。在本研究中，我们评估了韩国结肠假性梗阻（CPO）伴TZ患者的病理特征及其与长期预后的关系。
我们纳入了39例药物治疗无效且于1989年11月至2016年4月期间接受结肠切除术的CPO患者（症状发作时的中位年龄：45岁[四分位间距，29 - 57岁]，男性占46.2%）。TZ被定义为连接近端扩张段和远端未扩张段的结肠段。进行了详细的病理分析。
39例患者中，37例（94.9%）存在TZ，2例（5.1%）未显示明确的TZ。在TZ（+）患者中，经结肠周长校正后，TZ处的中位神经节细胞密度与近端扩张段和远端未扩张段相比显著降低（9.2对254.3和150.5，＜0.001）。在TZ（+）患者中，6例有其他病理表现，包括嗜酸性神经节炎（n = 2）、合并巨细胞病毒感染的溃疡（n = 2）、弥漫性缺血改变（n = 1）和异位肌间神经丛（n = 1）。在随访期间（中位时间，61个月），32例（82.1%）TZ（+）患者术后恢复且无症状复发。除神经节减少外的病理特征的存在是术后症状复发的独立预测因素（ = 0.046）。
大多数韩国CPO患者的TZ中可发现神经节减少。除TZ相关的神经节减少外，其他病理特征的检测与术后不良预后相关。
