Okamoto E, Satani M, Kuwata K
Surg Gynecol Obstet. 1982 Dec;155(6):823-8.
On the specimens taken at autopsy from three newborns with Hirschsprung's disease and three newborns in the control group, the innervation of the pelvic organs was histologically studied. The authors found that all the pelvic organs, except for the rectum in patients with Hirschsprung's disease, preserved a completely normal innervation not only of pelvic autonomic nerve plexuses, but also of sensory nerves of spinal origin. Even in the wall of the aganglionic rectum, the extrinsic sympathetic as well as parasympathetic nerve fibers were preserved, which showed a marked proliferative change due to the absence of target nerve cells upon which they otherwise terminated. An additional embryologic study was performed upon 20 human embryos. The results revealed that the pelvic nerve plexuses were formed during the six to ten gestational week period by neural cells migrating along the pelvic visceral branches of sacral nerves, while none of these neural cells was found to enter the rectum. The enteric plexuses of the rectum were formed later by neural cells that migrated down along the alimentary tract in a craniocaudal manner. The two separate origins, the sacral for the pelvic nerve plexuses and the vagal for the enteric plexuses of the rectum, seem to be the reason why innervation of the genitourinary organs, which are located in front of the aganglionic rectum, is normal in those patients with Hirschsprung's disease.
对3例患有先天性巨结肠症的新生儿及3例作为对照组的新生儿进行尸检取样，对盆腔器官的神经支配进行了组织学研究。作者发现，除先天性巨结肠症患者的直肠外，所有盆腔器官不仅保留了盆腔自主神经丛的完全正常神经支配，还保留了脊髓起源的感觉神经的完全正常神经支配。即使在无神经节的直肠壁中，外在的交感神经和副交感神经纤维也得以保留，由于缺乏它们原本终止于其上的靶神经细胞，这些神经纤维呈现出明显的增殖性变化。对20个人类胚胎进行了额外的胚胎学研究。结果显示，盆腔神经丛在妊娠6至10周期间由沿骶神经盆腔内脏分支迁移的神经细胞形成，而未发现这些神经细胞进入直肠。直肠的肠神经丛后来由沿消化道头向尾迁移的神经细胞形成。盆腔神经丛起源于骶神经，直肠肠神经丛起源于迷走神经，这两个不同的起源似乎是先天性巨结肠症患者中位于无神经节直肠前方的泌尿生殖器官神经支配正常的原因。
