Investigation On The Clinical And Pathology For Diagnosos Hirschs Prung And Allied HD

Objective: To retrospective studies the pathomorphological characteristics of proximate margin incisalis on the recurrence case of through radical macrosigmoid operation by using S-100 protein and neuron specific enolose immunohistochemical staining techniques to count and observe the shape of nerve fibers and gangliocellular, in order to investigate the pathology characteristic and the cause of surgery recurrence on the HD and HAD. Seeking the diagnosis exact rate by combination in AChE and NSE immunohistochemical staining on the freezing section for HD and HAD, further identify the surgical ablation scope.Methods: The first portion: the study collect 33 cases recurrent tissue slice which preoperative diagnosis HD and HAD treated with radical operation from April 2003to March 2010. Take serial section about five to seven from down to upper cutting at proximate tissue as experimental group, at the same time take thirty cases as normal control from unhirschsPrung and allied HD diseases. Immunohistochemisty labeling were performed with NSE and S-100 to evaluate edge through obervation nerve fibers and ganglioneure. Nine in thirty-three cases were treated with vicesradical operation and review the edge. The second portion: collect 74 cases tissue slice under BE opacification diagnosis HD and HAD whice behave as chronicity constipation and treated with radical operation from April 2003 to March 2010 as experiment group. Take patho-report as control group compare the accurat rate middle-operation diagnostic.Results:1. 33 constipation recurrence cases proximate edge treated with S-100,NSE immunohistochemical staining,10 cases as HD+IND-B,6 cases as HD+hypoganglionosis,5 cases as gangliocyte immaturity, 6 cases as IND-B,5 cases as hypoganglionosis, 1 cases as neuron dysplasia,under gangliocyte and nervous plexus count, we found HD+IND-B and IND-B gangliocyte density and myenteric nerve plexus density increase obviously, compare with nomal group has predominance statistical significance(P<0.01), HD+hypoganglionosis gangliocyte density and myenteric nerve plexus density decrease obviously, compare with nomal group has predominance statistical significance(P<0.01), HD+gangliocyte immaturity and gangliocyte immaturity gangliocyte density and myenteric nerve plexus density similar with nomal intestinal canal, has no statistical significance(P>0.05). We found Nine in thirty-three constipation cases edge tissue has nomotrophic gangliocyte, 8 cases has normal defecating function without complication; 1 IND-B cases still has constipation, but symptom relieve; 1 in 24 cases take expectant treatment lose visit, 10 cases has normal defecating function; 13 cases need laxative and Fecal softener to relieve. Compare second operation group to expectant treatment group, the therapeutic efficacy surpass than expectant treatment has statistical significance(P<0.05).2.Review clinical history ststistics, patient age at most in 6 month to 1 year. The M-F ratio of HD is 6:1, the M-F ratio of HAD is 3:1. In the operation ,74 cases treated with AchE and NSE staining, take use of this dyeing feature get 54 in 74 cases is HD, compare with pathology (58/74)has no statistically significant(p=0.388), 12 in 74 cases is HAD,compare with pathology(15/74)has no statistically significant(p=0.75).Conclusions: This retrospective datas under Immunohistochemisty and mini-determinator analysis shows recurring patient after radical macrosigmoid operation are HAD, the abnormal edge is one of the most reason induce recurring. AchE staining and NSE immunohistochemical stains can assist the differential diagnosis HD and HAD in the operation.