摘要
目的 通过研究基于先天性巨结肠肠管切缘神经节细胞结构特点的快速冰冻切片病理检查分级标准与术后预后之间联系,探索这一标准作为指导先天性巨结肠术中切缘的可行性。方法 回顾性分析2014年1月至2018年8月于上海交通大学医学院附属新华医院治疗的205例先天性巨结肠症患儿的临床资料及病理结果。其中,男158例(77.1%),女47例(22.9%);短段型155例(75.6%),长段型30例(14.6%),全结肠型20例(9.8%)。根据冰冻切片中切缘神经节细胞的胞质及胞核组织病理学特征,将切缘分为6级,其中发育可、尚可与稍差为满意切缘,发育较差、差及无神经节细胞为不满意切缘。收集所有患儿术后随访数据以评估临床预后,并用儿童失禁与便秘评分系统预测术后肠功能情况。结果 205例先天性巨结肠患儿中,有33例(16.1%)术中首次冰冻病理提示不满意切缘,需向近端继续切除肠管。最终肠管近端切缘病理结果如下:发育良好6例(2.9%),发育尚可102例(49.8%),发育稍差85例(41.5%),发育较差12例(5.8%),无发育差及未见神经节细胞病例。术后中位随访时间为24.8个月(3.0~54.4个月)。近端切缘的病理等级与术后便秘及污粪之间存在显著相关性(P=0.011和<0.001)。PICSS量表评估结果表明术后肠功能改善与切缘病理等级之间存在正相关关系。结论 本研究初步证明该神经节细胞快速冰冻切片病理检查分级标准与术后预后存在关联,此分级标准对先天性巨结肠术中切缘选择具有一定的指导意义,有望进一步减少病变肠段切除不够或正常肠段切除过多的问题。
Objective To assess the practicability of a pathological grading system for ganglion cells in frozen sections for determining surgical margin of Hirschsprung's disease(HSCR)and predicting bowel function.Methods A total of 205 HSCR children were hospitalized from January 2014 to August 2018.There were 158 boys(77.1%)and 47 girls(22.9%).The clinical types of HSCR included short-segment(S-HSCR)(n=155,75.6%),long-segment(L-HSCR)(n=30,14.6%)and total colonic aganglionosis(TCA)(n=20,9.8%).Medical records and detailed pathologic results of intraoperative frozen sections were reviewed.Based upon the histopathological features of ganglion cells in frozen sections,ganglion cells were divided into six degrees.The identification of grades I-III ganglion cells was regarded as a symbol of an acceptable surgical margin and vice versa.Follow-up data were collected for evaluating the clinical outcomes.And a validated pediatric incontinence and constipation scoring system(PICSS)was utilized for predicting bowel function.Results The final pathologic results of proximal resected bowel were presented as follows:grade I(n=6,2.9%),grade II(n=102,49.8%),grade III(n=85,41.5%)and grade IV(n=12,5.8%).Thirty-three HSCR children(16.1%)required further resection of proximal bowel since initial specimens submitted for pathologic evaluation showed an unacceptable surgical margin.The median follow-up period was 24.8(3.0-54.4)months.A marked correlation was observed between the pathologic grade of proximal resected margin and postoperative constipation(P=0.011)and soiling(P<0.001).The results of PICSS hinted at a positive correlation between postoperative bowel function and better pathologic grade.Conclusions A pathological grading system of ganglion cells in frozen sections guides pediatric surgeons in precisely determining surgical margin during surgery and an excellent pathologic grade is correlated with satisfactory clinical outcomes.This pathologic grade system may provide a new method for intraoperative histopathologic consultations for preventing insufficient resection of affected colon.
作者
张旻中
蔡威
王俊
陈杰
潘伟华
吴湘如
祝明洁
管文斌
王立峰
吴晔明
Zhang Minzhong;Cai Wei;Wang Jun;Chen Jie;Pan Weihua;Wu Xiangru;Zhu Mingjie;Guan Wenbin;Wang Lifeng;Wu Yeming(Department of Pediatric General Surgery,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Pathology,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2020年第3期230-237,共8页
Chinese Journal of Pediatric Surgery
基金
国家自然科学基金重点项目(81630039)
上海市小儿消化与营养重点实验室(17DZ2272000)
上海市青年科技英才扬帆计划(19YF1432000)
上海市科委科技创新行动计划医学引导类科技支撑项目(19411968900)。
关键词
先天性巨结肠
病理诊断
病理组织学
术中冰冻切片分析
Hirschsprung disease
Pathologic diagnosis
Histopathology
Intraoperative frozen section analysis
