SEVERE IDIOPATHIC CONSTIPATION IS ASSOCIATED WITH A DISTINCTIVE ABNORMALITY OF THE COLONIC MYENTERIC PLEXUS
SEVERE IDIOPATHIC CONSTIPATION IS ASSOCIATED WITH A DISTINCTIVE ABNORMALITY OF THE COLONIC MYENTERIC PLEXUS
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DOI：
10.1016/s0016-5085(85)80128-1
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发表时间：
1985-01-01
期刊：
影响因子：
29.4
通讯作者：
POPE, CE
中科院分区：
文献类型：
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作者：
KRISHNAMURTHY, S;SCHUFFLER, MD;POPE, CE
我们分析了26名患有严重特发性便秘的女性患者的临床、影像学、食管测压和病理学特征。24例患者年龄在19 - 39岁之间。排便频率为5-28天一次。在钡灌肠检查中，24名患者中有9名患者的结肠长度增加，其中4名患者的结肠宽度增加（>10 cm）。23例患者放射性核素固体餐胃排空检查正常。22例患者中10例食管测压显示高振幅波，3例显示长持续时间波。直肠活检标本显示正常粘膜下神经元的所有患者和结肠黑变病6。12例患者因便秘接受结肠次全切除术。使用苏木精和伊红连续切片的常规光学显微镜检查显示：（a）4例患者结肠黑变病;（B）11例患者平滑肌正常;（c）1例患者环形肌变薄;（d）所有患者的肌间神经丛均无明显异常。相比之下，肌间神经丛的银染色显示：（a）10例患者嗜银神经元数量减少;（B）11例患者嗜银神经元形态异常;（c）11例患者轴突数量减少;（d）所有12例患者神经节内大小核数量增加。对8例便秘患者和19例对照者结肠银染色进行编码分析，结果表明，重度特发性便秘的病理改变可与对照者相鉴别。因此，严重的特发性便秘与病理学上可识别的肌间神经丛异常有关。这种异常似乎不同于任何先前描述的假性肠梗阻。
We analyzed the clinical, radiographic, esophageal manometric, and pathologic features of 26 women with severe, idiopathic constipation. Twenty-four patients were between 19 and 39 yr of age. Stool frequency was once every 5–28 days. On barium enema examination, 9 of 24 patients had colons of increased length and 4 of these 9 patients had colons of increased width (>10 cm). Radionuclide solidmeal gastric-emptying studies were normal in 23 patients tested. Esophageal manometry demonstrated high-amplitude waves in 10 of 22 patients and long-duration waves in 3 of these 10 patients. Rectal biopsy specimens showed normal submucosal neurons in all patients and melanosis coli in 6. Twelve patients underwent subtotal colectomies for constipation. Conventional light microscopy using hematoxylin and eosin serial sections showed (a) melanosis coli in 4 patients; (b) normal smooth muscle in 11; (c) thinning of the circular muscle in 1; and (d) no apparent abnormalities of the myenteric plexus in any. In contrast, silver stains of the myenteric plexus showed (a) quantitatively reduced numbers of argyrophilic neurons in 10 patients; (b) morphologically abnormal argyrophilic neurons in 11; (c) decreased numbers of axons in 11; and (d) increased numbers of variably sized nuclei within ganglia in all 12. A coded analysis of the silver stains of colons from 8 patients with constipation and 19 control cases demonstrated that the pathologic abnormalities of severe idiopathic constipation could be differentiated from controls. Thus, severe idiopathic constipation is associated with a pathologically identifiable abnormality of the myenteric plexus. This abnormality appears different from anything previously described in intestinal pseudoobstruction.