Electrical stimulation of the vagus nerve restores motility in an animal model of achalasia
Electrical stimulation of the vagus nerve restores motility in an animal model of achalasia
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DOI：
10.1016/s1091-255x(03)00152-5
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发表时间：
2003-11-01
影响因子：
3.2
通讯作者：
Swanstrom, LL
中科院分区：
文献类型：
--
作者：
Khajanchee, YS;VanAndel, R;Swanstrom, LL
贲门失弛缓症手术治疗后，食管扩张通常不会恢复正常。已知迷走神经的直接电刺激可刺激正常食管中的顺行性痉挛;然而，尚不清楚一旦确立失弛缓症样疾病，电刺激是否会诱导痉挛复发。本研究的目的是在失弛缓症动物模型中进行迷走神经电刺激期间的运动的定量和定性测量。使用已经建立和验证的使用成年北美负鼠（Didelphis virginiana）的动物失弛缓症模型。15只负鼠被分为3组。对三只动物（第1组）进行假手术。在第2组（n = 6）中，在胃食管交界处放置一个松散的Gore-Tex带（食管周长的110%），以防止吞咽期间食管下括约肌松弛。在第3组（n = 6）中，使用相对较紧的带（食管周长的90%）进一步升高下食管括约肌压力。在6周时，在测压和放射学证实贲门失弛缓症后，在移除带之前和之后使用渐变方波电刺激进行食管电刺激。食管神经丛的变化进行了组织学评估。使用标准统计技术比较术前和术后测压数据。第1组假手术后食管特征和运动性无差异。第2组动物表现出各种各样的贲门失弛缓症（高幅度、同时、重复收缩）、中度食管扩张和40%至60%的肌内神经丛变性。第3组动物出现不动性贲门失弛缓症，伴有典型的低幅度同步（镜像）收缩、严重扩张（“鸟嘴”）食管和50%至65%的神经丛变性。第2组迷走神经刺激显示收缩幅度显著增加（P < 0.001），并且在带移除前49%的吞咽中蠕动活动恢复。带移除后，所有收缩均为蠕动。在第3组中，在移除带之前和之后迷走神经刺激显示收缩幅度显著增加（P < 0.0001），但是在移除带之前没有恢复传播性收缩，然而，在移除带之后，44%的收缩在食管的平滑部分中是进行性的。电刺激迷走神经改善了食管收缩力，无论疾病的严重程度如何;然而，蠕动活动完全恢复正常，只有在剧烈的（早期）各种贲门失弛缓症。在重度贲门失弛缓症患者中，通过迷走神经起搏清除功能性食管出口梗阻（如肌切开术）可能对获得显著的扩张是必要的。(C)2003年消化道外科学会
Esophageal peristalsis generally does not return to normal after surgical treatment of achalasia. Direct electrical stimulation of the vagus nerve is known to stimulate antegrade peristalsis in the normal esophagus; however, it is not known whether electrical stimulation will induce return of peristalsis once an achalasia-like disorder has been established. The objective of this study was to perform quantitive and qualitative measurements of motility during electrical stimulation of the vagal nerve in an animal model of achalasia. An already established and verified animal achalasia model using adult North American opossums (Didelphis virginiana) was used. Fifteen opossums were divided into three groups. Sham surgery was performed on three animals (group 1). In group 2 (n = 6) a loose Gore-Tex band (110% of the esophageal circumference) was placed around the gastroesophageal junction to prevent relaxation of the lower esophageal sphincter during swallowing. In group 3 (n = 6) a relatively tighter band (90% of the esophageal circumference) was used to further elevate the lower esophageal sphincter pressure. At 6 weeks, after manometric and radiolologic confirmation of achalasia, electrical stimulation of the esophagus was performed before and after removal of the band using a graduated square-wave electrical stimulus. Changes in esophageal neural plexi were assessed histologically. Pre- and postoperative manometric data were compared using standard statistical techniques. No difference was observed in esophageal characteristics and motility after sham surgery in group 1. Animals in group 2 demonstrated a vigorous variety of achalasia (high-amplitude, simultaneous, repetitive contractions), moderate esophageal dilatation, and degeneration of 40% to 60% of intramuscular nerve plexi. Animals in group 3 developed amotile achalasia with typical low-amplitude simultaneous (mirror image) contractions, severely dilated ("bird beak") esophagus, and degeneration of 50% to 65% of nerve plexi. Vagal stimulation in group 2 demonstrated a significant increase in the amplitude of contractions (P < 0.001) and return of peristaltic activity in 49% of swallows before band removal. After band removal, all of the contractions were peristaltic. In group 3 vagal stimulation before and after removal of the band demonstrated a significant increase in amplitude of contractions (P < 0.0001) but no return of propagative peristalsis before band removal, however, 44% of contractions were progressive in the smooth portion of the esophagus after removal of the band. Electrical stimulation of the vagus nerve improved the force of esophageal contractions irrespective of the severity of the disease; however, peristaltic activity completely returned to normal only in the vigorous (early) variety of achalasia. Removal of the functional esophageal outlet obstruction, as with a surgical myotomy, may be necessary to obtain significant peristalsis with vagal pacing in severe achalasia. (C) 2003 The Society for Surgery of the Alimentary Tract