Federal State Government-Financed Educational Institution of Higher Education "Volgograd State Medical University" of the MH RF, Volgograd, Russia.
Department of Surgery, Federal State Autonomous Institution "National Medical Research Center of Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia.
J Laparoendosc Adv Surg Tech A. 2021 Dec;31(12):1397-1401. doi: 10.1089/lap.2021.0348. Epub 2021 Nov 16.
Chronic appendicitis (CA) is a diagnosis characterized by long-standing right lower quadrant pain. We analyzed clinical, morphological, and immunohistochemical studies of the appendix to confirm the adequacy of surgery for CA in children . We carried out comparative studies of clinical presentations and results of morphological and immunohistochemical studies of remote appendicitis in 55 children with chronic recurrent lower quadrant pain (CRLQP). Morphological and immunohistochemical studies revealed three types of changes in the appendix. Type 1 ( = 21)-chronic inflammation. Inflammatory leukocyte infiltration was localized within the mucous membrane of the appendix. An immunohistochemical study revealed a significant ( < .01) increase in the expression of CD106 (vascular cell adhesion molecule 1) and in the number of matrix metalloproteinase 9 (MMP-9) positive cells. Type 2 ( = 20)-lymphoid hyperplasia. Morphological changes were characterized by lymphoid infiltration of the mucosa and submucosa of the appendix. Immunological changes were characterized by an increase ( < .01) in the expression and number of MMP-9, expression of CD106 positive cells, an increase in the expression of collagen IIIα in combination with a decrease in the expression and number of positive vascular endothelial growth factor (VEGF) and vasoactive intestinal peptide cells. Type 3 ( = 12)-catarrhal inflammation. Morphological changes were characterized by impaired blood circulation only in the mucous membrane, without destructive or inflammatory changes. Immunological changes were characterized by an increase ( < .01) in the expression and number of VEGF-positive cells, which may indicate a response to local hypoxia of the appendix and explain neovascularization in a chronic condition. The abdominal syndrome after appendectomy was noted to disappear in 89% of patients. The established changes in remote appendicitis, other than acute inflammation, make it possible to consider reasonable appendectomy a way of treating CRLQP in children. We have identified immunohistochemical and morphological changes pointing to autoimmune and vascular mechanisms of appendix damage in children with CRLQP. Laparoscopic appendectomy helps to eliminate abdominal pain in most CA patients.
慢性阑尾炎（CA）的诊断特征为长期右下腹痛。我们分析了阑尾的临床、形态和免疫组织化学研究，以确认儿童 CA 手术的充分性。我们对 55 例慢性复发性右下腹痛（CRLQP）患儿的远程阑尾炎临床表现和形态学及免疫组织化学研究结果进行了对比研究。形态学和免疫组织化学研究显示，阑尾有三种类型的变化。1 型（ = 21）-慢性炎症。炎症性白细胞浸润局限于阑尾的黏膜内。免疫组织化学研究显示 CD106（血管细胞黏附分子 1）表达显著增加（ < .01），基质金属蛋白酶 9（MMP-9）阳性细胞数增加。2 型（ = 20）-淋巴组织增生。形态学改变表现为阑尾黏膜和黏膜下层淋巴浸润。免疫学改变表现为 MMP-9 表达和阳性细胞数增加（ < .01），CD106 阳性细胞表达增加，胶原 IIIα 表达增加，同时血管内皮生长因子（VEGF）和血管活性肠肽阳性细胞表达和数量减少。3 型（ = 12）-卡他性炎症。形态学改变仅表现为黏膜血液循环受损，无破坏或炎症改变。免疫学改变表现为 VEGF 阳性细胞表达和数量增加（ < .01），这可能表明阑尾局部缺氧的反应，并解释慢性状态下的新血管生成。阑尾切除术后的腹部综合征在 89%的患者中消失。除急性炎症外，其他远程阑尾炎的既定变化使我们能够考虑合理的阑尾切除术作为治疗儿童 CRLQP 的方法。我们已经确定了指向儿童 CRLQP 阑尾损伤的自身免疫和血管机制的免疫组织化学和形态学变化。腹腔镜阑尾切除术有助于消除大多数 CA 患者的腹痛。
