Research Of Surgical Treatment And Study On Distribution Of Interstitial Cells Of Cajal In The Colon Of Patients For Slow Transit Constipation.

Slow transit constipation (STC) is a colonic motor disorder, which is characterized by measurably delayed movement of materials through the colon. Although abnormalities in the neuronal networks of the colon have been demonstrated. in patients with STC, the aetiology of it remains unclear. The severity of its symptoms and the failure of the conservative therapy ultimately led to colectomy for some patients with STC.However,a number of patients experience postoperative side effects such as diarrhea, recurrence of constipation, adhesive ileus It is capital for STC how to re-evaluate surgical treatment and diagnose of STC,how to clear range of disorder for high elective colectomy. Interstitial cells of Cajal (ICC) have been shown to be the pacemaker cells of the intestine and have been implied in the pathogenesis of a number of gastrointestinal motility dysfunction including idiopathic slow transit constipation.It will be a major breakthrough in this field to search for on distribution of interstitial cells of Cajal in the colon of patients with STC. In this present study cases with constipation were examined by colonic transit test, pelvicography and colpocystodefecography, anorectal manometry, pancolonic manometry. according to the result, cases were classified and diagnosed for range of disorder and experienced high elective colectomy. Based on the routine microscope examination, the distribution and configuration of ICC were observed with immunohistochemistry. With an indirect immunofluorescence staining, ICC were examined with a laser scanning confocal microscope and the area occupied by ICC were calculated with an image analysis system. And the ultrastructure of ICC were observed by an electron microscope. The results were as following:1.Colonic transit test is a preferred and signifiable examination techniques for STC. Pelvicography and colpocystodefecography, anorectal manometry can find hiding complaint of pelvic floor.It is needs and necessary for diagnoses of STC.By anorectal manometry,the results may provide diagnostic information. Different constipation have different results. Different results can represent different pathogenesis.So according to different pathogenesis and results,we used different surgical treatment. The pressure of colon between the normal and the constipational is different. The measurement of pancolonic manometry is useful for the slow transit constipation patient to have high elective colectomy.93 percent of the patients recovered well and have a normal frequency of defecation 6 months postoperatively. The surgical treatment is valuable for the slow transit constipation treatment.2. The data suggest that ICC distribution is relatively uniform throughout the human colon and that decreased ICC volume is pan-colonic in slow transit constipation. The remaining ICC in the STC patients appeared blunted and shorter when compared with processes from ICC visualized in the controls. The myenteric plexus ICC is denser in the caecum colon. So we presume the caecum is the primary colonic pacemaker site. Our studies revealed decreased area of c-kit positice ICC in the STC colon, which may play an important role in the pathogenesis of STC. H-E staining displayed that most patients have no obvious abnormal presentation. Electron microscope showed that ICC were relatively sparsity. The Space between ICC and smooth muscle enlarged. Decreased or abnormal ICC found within the STC colon may not related to cell degeneration, apoptosis, or necrosis.