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目的:测定一氧化氮(NO)在先天性肥厚性幽门狭窄(CHPS)肥厚肌中的改变,血中含量及术前术后的改变,探讨 CHPS 的发生和病理生理改变。方法:用还原性辅酶Ⅱ(NADPHd)组织化学染色法测定组织中一氧化氮合酶(NOS)含量;用比色法测定血中 NO 含量。21例 CHPS 术中取幽门肥厚之肌层;5例作幽门疾病取幽门肌层。结果:CHPS 组肥厚之环状肌层无 NADPHd(+)神经纤维染色,偶见扭曲、变形、染色浅的神经纤维。非幽门疾病组幽门环状肌、纵状肌、肌间神经元显示强 NADPHd(+)染色。血中 NO 含量 CHPS 组和非幽门疾病组之间差异无显著性(P=0.6);CHPS 组术前术后之间差异无显著性(P=0.5)。结论:CHPS 患儿肥厚之环状肌中NOS 缺如或明显减少,致幽门失松弛,幽门梗阻。血中 NO 含量因受多种因素影响,病理生理意义不完全明了,推测 CHPS 可能是定位于幽门的局限性疾病。
OBJECTIVE: To determine the changes of nitric oxide (NO) in the hypertrophic muscle of congenital hypertrophic pyloric stenosis (CHPS), the content of blood and the changes before and after operation, and to explore the occurrence and pathophysiological changes of CHPS. Methods: The content of nitric oxide synthase (NOS) in tissue was determined by NADPHd histochemical staining. The content of NO was determined by colorimetry. 21 cases of CHPS intraoperative pyloric hypertrophy of the muscular layer; 5 cases of pyloric disease for pyloric muscle. Results: The hypertrophic ring muscle of CHPS group had no NADPHd (+) nerve fiber staining, and occasionally distorted, deformed and dyed shallow nerve fibers. Non-pyloric disease group pyloric ring muscle, longitudinal muscle, myenteric neurons showed strong NADPHd (+) staining. There was no significant difference in blood NO level between CHPS group and non-pyloric disease group (P = 0.6). There was no significant difference between CHPS group before and after operation (P = 0.5). CONCLUSIONS: The absence or decrease of NOS in the hypertrophic ring muscle of CHPS children leads to relaxation of pylorus and pyloric obstruction. Blood levels of NO due to many factors, the pathophysiological significance is not fully understood, suggesting that CHPS may be localized in pylorus localized disease.