Objective:To study the distributions and significance of enteric ganglion cells and nerve fiber above the dentate line of Hirschsprung's disease (HD) in different age groups, and to explore the exact area for transrectal myometrial biopsy. Methods:The HD patients undergoing radical operation were divided into three groups,i.e., neonatal group (group A), infant group (group B) and child group (group C). Samples were taken continuously from 2-4 cm above the dentate line and stained with HE and calretinin. The changes and the distributions of enteric ganglion cells, nerve plexus and nerve fiber above the dentate line were observed. Results:No ganglion cells from dentate line to spasmodic segments in three groups were observed, which was significantly different from those of dilated segments (P<0.01).Nerve plexus and nerve fiber in 1 cm, 2 cm and 2.5 cm above the dentate line were scarcely found in group A, group B, and group C respectively, but the thickening and denaturating nerve fiber and hyperplastic nerve plexus beyond those segments were observed. There were significant differences between the two segments in each group (P<0.01). Calretinin staining played an important role in observing ganglion cells. Conclusion:There is a "physiological non-ganglion cells" area above the dentate line of Hirschsprung's disease. The distribution of this area varies in different ages,and the area should be avoided when the specimens are taken. By analyzing the morphology of nerve plexus and nerve fiber, and by combining it with the results of calretinin staining, we can effectively distinguish "physiological non-ganglion cells" area from intestinal lesion of Hirschsprung disease and avoid misdiagnosis.
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