Puri P, Fujimoto T
Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland.
J Pediatr Surg. 1988 Jun;23(6):546-54. doi: 10.1016/s0022-3468(88)80366-x.
There are a number of conditions that clinically resemble Hirschsprung's disease despite the presence of ganglion cells on rectal biopsies. These conditions have been described under various names. There have been no systematic studies to date to distinguish these conditions from one another. We examined biopsy and surgical specimens from 19 cases of allied functional bowel disorders in an attempt to establish the most appropriate diagnostic procedure. Suction rectal biopsy and full thickness surgical biopsy specimens were examined by enzyme histochemistry (AChE), immunocytochemistry (monoclonal antibody D7), silver impregnation, and electronmicroscopy. Monoclonal antibody D7, which was produced in our own laboratory, is a good marker of autonomic nervous system. This unique antibody allowed us to distinguish various neuronal abnormalities of the bowel except the abnormalities of the argyrophil plexus, which were diagnosed by silver staining. Eight of the 19 cases had a smooth muscle disorder that was only diagnosed on electronmicroscopy. Our data suggest that the vast majority of allied functional bowel disorders can be diagnosed by examining a full thickness rectal biopsy by immunocytochemistry (D7 monoclonal antibody), silver impregnation, and electronmicroscopy.
尽管直肠活检显示存在神经节细胞，但仍有许多临床症状类似于先天性巨结肠的病症。这些病症有多种不同的命名。迄今为止，尚无系统研究来区分这些病症。我们检查了19例相关功能性肠病的活检和手术标本，试图确立最合适的诊断方法。通过酶组织化学（乙酰胆碱酯酶）、免疫细胞化学（单克隆抗体D7）、银浸染和电子显微镜检查对直肠吸引活检和全层手术活检标本进行了检测。我们自己实验室制备的单克隆抗体D7是自主神经系统的良好标志物。这种独特的抗体使我们能够区分肠道的各种神经元异常，但不包括嗜银神经丛的异常，嗜银神经丛异常通过银染色诊断。19例中有8例存在平滑肌疾病，仅通过电子显微镜检查得以诊断。我们的数据表明，绝大多数相关功能性肠病可通过免疫细胞化学（D7单克隆抗体）、银浸染和电子显微镜检查全层直肠活检来诊断。
