Ohi R, Yamaguchi M, Komatsu K, Kato H, Kasai M
Nihon Geka Gakkai Zasshi. 1985 Sep;86(9):1281-3.
In order to establish the diagnostic criteria of Hirschsprung's disease by Ach. E. staining of rectal mucosal biopsy, we analysed the specimen obtained from 110 infants with abdominal distension and constipation. We found the pattern of nerve fiber proliferation was not uniform even in patients with Hirschsprung's disease. The pattern was classified into 4 types. I. total layer type (Typical type), II. lamina propria mucosal type, III. lamina submucosal type, and IV. lamina propria mucosal and lamina submucosal type. In case of types II, III, IV which do not show a typical finding, detection of Meissner's ganglion cells is the most important factor for the diagnosis of Hirschsprung's disease. Since we confirmed that the Meissner's ganglion cells were always present at the level of just above to the dentate line of the rectum in the specimen of normal controls, we concluded that 5mm oral to the dentate line was the most appropriate position of the rectal mucosal biopsy for the diagnosis of Hirschsprung's disease including patients with ultrashort segment aganglionosis. Two points rectal mucosal biopsies, namely, the biopsies from the site of 5mm and 5 cm oral to the dentate line, was useful for selection of surgical treatment in patients with short segment aganglionosis.
为了通过直肠黏膜活检的乙酰胆碱酯酶（Ach.E.）染色来建立先天性巨结肠的诊断标准，我们分析了110例腹胀和便秘婴儿的标本。我们发现，即使在先天性巨结肠患者中，神经纤维增生模式也不一致。该模式分为4种类型。I. 全层型（典型型），II. 黏膜固有层型，III. 黏膜下层型，IV. 黏膜固有层和黏膜下层型。在II、III、IV型未显示典型表现的情况下，检测Meissner神经节细胞是先天性巨结肠诊断的最重要因素。由于我们证实正常对照标本中Meissner神经节细胞总是存在于直肠齿状线以上的水平，我们得出结论，齿状线以上5mm是直肠黏膜活检诊断先天性巨结肠（包括超短段无神经节症患者）的最合适位置。两点直肠黏膜活检，即从齿状线以上5mm和5cm处取材，对于短段无神经节症患者的手术治疗选择是有用的。
