Watanabe Y, Ito T, Harada T, Kobayashi S, Ozaki T, Nimura Y
First Department of Surgery, Nagoya University School of Medicine, Japan.
J Pediatr Surg. 1995 Oct;30(10):1471-6. doi: 10.1016/0022-3468(95)90410-7.
The distribution and pathways of extrinsic enteric nerves in the aganglionic segment in Hirschsprung's disease have not completely delineated. The zinc iodide-osmic acid method was used to investigate nerve fibers of the intestine in aganglionic rats. A light microscope equipped with a polarizing filter system clarified the major pathways and the fine distribution of extrinsic nerves in the aganglionic segment of a long-segment aganglionic rat model. Two sets of extrinsic nerve strands were observed in the distal aganglionic colon; one consisted of a continuous hypertrophied network located between the longitudinal and circular muscle coats, and the other involved branches that coursed along the blood vessels in the submucosal layer and that originated in the nearby mesentery. These two sets of nerve strands were connected by fine nerve fibers. Hypertrophied myenteric nerve strands were also present in normal (ganglionic) colon, fewer strands were found in the proximal aganglionic colon, and none were found in the ileum. The authors speculate that the ascending extrinsic nerve strands disappear from the ileum in cases of long-segment colonic aganglionosis, by the same mechanism that occurs in normally innervated bowel.
先天性巨结肠症无神经节段中外源性肠神经的分布及通路尚未完全明确。采用碘化锌-锇酸法研究无神经节大鼠的肠神经纤维。配备偏振滤光系统的光学显微镜明确了长节段无神经节大鼠模型无神经节段中外源性神经的主要通路及精细分布。在远端无神经节结肠中观察到两组外源性神经束；一组由位于纵肌层和环肌层之间的连续肥大网络组成，另一组包括沿黏膜下层血管走行且起源于附近肠系膜的分支。这两组神经束由细神经纤维相连。正常（有神经节）结肠中也存在肥大的肌间神经束，近端无神经节结肠中神经束较少，而回肠中未发现。作者推测，在长节段结肠无神经节症病例中，回肠中外源性神经束的上行部分通过与正常神经支配肠段相同的机制消失。
