ObjectiveTo explore the clinical value of modified Soave procedure with stapler for the treatment of Hirschsprung disease. MethodsThe clinical data of 26 patients with Hirschsprung disease adimitted in No.477 hospital from January 2002 to December 2010 were analyzed retrospectively. All the patients underwent modified Soave operation with rectal mucosa and proximal intestine stapled end-to-end. ResultsAll operations were successful without anastomotic leakage, aponeurosis of investment infection, and colonitis. Increased stool frequency presented in two cases, which were cured with astringents on day 15 and 30 after operation, respectively. Mild fecal contamination was in one case. All cases were followed up between 3 months to 60 months, with an average 32 months, without incontinence and constiptation. ConclusionModified Soave procedure with stapler is safe and effective for the treatment of Hirschsprung disease in elder children and adult.
ObjectiveTo explore the expression of growth associated protein-43 (GAP-43) in spasm segment and expansion segment of hirschsprung disease (HD), and to explore the pathogenesis of HD. MethodsThe expression of GAP-43 in 30 patients with HD who underwent surgical resection for absence of enteric plexuses from Jan. 2012 to Jun. 2013 in Shen zhen Children's Hospital were analyzed by using immunohistochemistry method and real-time PCR method. Aganglionic tissues of all patients were included as spasm group, and ganglionic tissues of the same patients were served as expansion group. Then comparison of the expression levels of GAP-43 mRNA and its protein between 2 groups was performed. Resultsof real-time RCR showed that the expression level of GAP-43 mRNA in expansion group was higher than that of spasm group (0.119 0 vs. 0.052 8, P<0.05). Immunohistochemistry results showed that GAP-43 protein expressed both in the myenteric plexus and ganglionic plexus of submucos in all patients, but lighter in spasm group. Compared with ganglionic plexus of circular muscle layer and longitudinal muscle layer/ganglionic plexus of submucosa in expansion group, the average optical density values at corresponding sites of intestinal tissues in spasm group were both lower (P<0.05). ConclusionExpression of GAP-43 protein is lower in spastic intestinal tissue of patients with HD, which suggests that down-regulation of GAP-43 protein may be a risk factor for HD.