Hirschsprung氏病腸管の自律神経支配について—主として組織化学的研究

HISTOCHEMICAL STUDY ON THE AUTONOMIC NERVOUS SYSTEM IN THE INTESTINAL TRACT OF HIRSCHSPRUNG'S DISEASE

はじめに

　Hirschsprung氏病に関する研究は，1882年にHirsch—sprung^6）が初めて先天性疾患として発表して以来Whitehouse^17），Swenson^14,15），Hiatt^8）等のすぐれた業績がある。

　元来，この疾患は肛門側の腸管の狭窄とその口側腸管の拡張を呈し，臨床的に頑固な便秘を来す疾患である。このような所見に対し種々の研究が行なわれており，研究初期においては腸管拡張部に病変因子が存在するがごとく考えられていたこともあつたが，Wade,Royle，Scott,Morton等が自律神経支配の異常説を述べるようになり，その後Dalle valle,Whitehouse^17），植田，岡本^13），等により腸管壁内神経叢の変化が認められ現在では病変部が肛門側の狭窄部でこの部位がaganglionicsegmentであることが確認されている。このように最近の見解は腸管狭窄部の自律神経分布状態が，先天的に異常であると考えられているので，著者はHirschsprung氏病腸管の自律神経支配を知る為に組織化学的方法および鍍銀法を用いその分布形態を検討した。

The intestinal tract of Hirschsprung's disease wasclassified into three portions: the narrow segment,the middle segment and the dilated segment, andthe intramural autonomic nerve system in each seg-ment was studied by means of histochemical methodand silver staining.

Cathecholamine (CA) histochemistry was appiedfor the detection of adrenergic nerve, and acetyl-choline esterase (AChE) staining was carried outfor the detection of acetylcholine reactive nerve.

The dilated segment showed the same findingsas the normal intestine, that is, CA fluorescentnerves and AChE reactive nerves were observedin networks or in basket-like shapes surroundingthe intramural ganglion cells which mainfestedAChE activity.

In the middle segment, AChE reactive intramuralganglion cells, CA fluorescent nerves and AChEreactive intramural nerve plexus were observed inlesser density and number than in the dilated seg-ment.

In the narrow segment, these intramural ganglioncells and nerve plexus were completely absent, butlarge nerve bundles of AChE activity were scat-tered in the interspace between the circular andthe longitudinal muscle layers where the intramuralnerve plexus was lacking.

However, in submucosa, muscularis, subserosaand the arterial wall of the dilated segment, themiddle segment, and the narrow segment, the CAfluorescent and AChE reactive nerves were observedundergoing almost Silver staining method also con-firmed the above-mentioned findings.