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目的探讨小肠闭锁术后发生肠动力功能障碍的原因及手术切除病变肠管范围。方法对小肠闭锁手术切除小肠标本15例及对照组6例非肠道或神经系统疾病死亡的足月新生儿尸检小肠标本肠壁S-100蛋白、α-平滑肌肌动蛋白(α-SMA)和c-kit蛋白进行免疫组化研究,观察闭锁两端肠壁肠神经系统(ENS)、平滑肌和肠间质细胞(ICCs)病理改变及其分布范围,并行统计学处理。结果闭锁近端肠壁S-100、α-SMA和c-kit阳性表达明显低于对照组,随远离盲端,以上指标呈逐渐增加趋势。在闭锁近端16cm、远端4cm处,三者病变总体趋于正常。结论小肠闭锁两端肠壁与肠动力密切相关的ENS、平滑肌和ICCs均存在病变,是小肠闭锁术后发生肠道动力功能障碍的原因。在患儿小肠长度允许的情况下,切除闭锁近端肠管16cm以上,而远端切除4cm,可减少或避免术后肠动力功能障碍的发生。
Objective To investigate the causes of intestinal motility dysfunction after small intestine atresia and the range of bowel resection. Methods The intestinal wall S-100 protein, α-smooth muscle actin (α-SMA) and the expression of α-smooth muscle actin (α-SMA) were detected in 15 cases of small intestine resection and 6 cases of control group. Immunohistochemical study of c-kit protein was performed to observe the pathological changes and their distribution of intestinal wall intestine (ENS), smooth muscle and intestinal interstitial cells (ICCs) at both ends of the occlusion and statistical analysis. Results The positive expressions of S-100, α-SMA and c-kit in the proximal intestinal wall were significantly lower than those in the control group. The above indexes showed a gradual increasing trend away from the blind end. In the closed proximal 16cm, distal 4cm, the three lesions tend to be normal. Conclusion ENS, smooth muscle and ICCs, which are closely related to intestinal motility in the intestinal wall at both ends of the small intestine, are all pathological factors that cause intestinal motility dysfunction after small bowel atresia. In the case of children with small intestine length, removal of proximal locking bowel more than 16cm, and the distal resection 4cm, can reduce or avoid postoperative intestinal motility dysfunction.