ENTEROCOLITIS ASSOCIATED WITH HIRSCHSPRUNGS-DISEASE - A CLINICAL HISTOPATHOLOGICAL CORRELATIVE STUDY
ENTEROCOLITIS ASSOCIATED WITH HIRSCHSPRUNGS-DISEASE - A CLINICAL HISTOPATHOLOGICAL CORRELATIVE STUDY
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DOI：
10.1016/0022-3468(95)90334-8
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发表时间：
1995-07-01
影响因子：
2.4
通讯作者：
HEIDELBERGER, KP
中科院分区：
文献类型：
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作者：
ELHALABY, EA;TEITELBAUM, DH;HEIDELBERGER, KP
先天性巨结肠症（HEC）相关的小肠结肠炎仍然是发病率甚至死亡率的主要来源，无论是在明确的手术治疗之前还是之后。本研究旨在探讨在没有HEC临床表现的情况下，组织病理学粘膜变化是否可以预测该并发症的后续发展。将25例最终发展为临床HEC的患者的临床数据和组织病理学与对照组25例年龄和性别匹配的先天性巨结肠（HD）患者进行比较，但术前或术后均无临床HEC。通过直肠活检或剖腹手术获得的组织的组织病理学结果根据严重程度从0到V分级，并与最终的临床过程进行比较。本研究表明：（1）HEC的组织病理学表现似乎可以预测临床HEC的临床发展，但不能预测其严重程度;（2）大于或等于11的组织学等级（每个高倍视野大于或等于2个隐窝破裂）应引起对随后发生HEC的怀疑，而大于或等于III级（多发性隐窝扩张）使儿童处于临床HEC发展的高风险中;和（3）与通常认为的相反，HEC的组织病理学变化发生在神经节和无神经节段中。基于这些发现，建议HEC的组织病理学记录及其分级应成为HD组织诊断的组成部分。版权所有（C）1995由W.B.桑德斯公司
Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of greater than or equal to 11 (greater than or equal to 2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of greater than or equal to III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally thought, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade, should be an integral part of the tissue diagnosis of HD. Copyright (C) 1995 by W.B. Saunders Company