The impact of surgical excisions on human gastric slow wave conduction, defined by high-resolution electrical mapping and in silico modeling.
The impact of surgical excisions on human gastric slow wave conduction, defined by high-resolution electrical mapping and in silico modeling.
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DOI：
10.1111/nmo.12637
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发表时间：
2015-10
影响因子：
3.5
通讯作者：
O'Grady G
中科院分区：
文献类型：
--
作者：
Du P;Hameed A;Angeli TR;Lahr C;Abell TL;Cheng LK;O'Grady G
胃收缩由慢波协调，慢波由Cajal间质细胞（ICC）产生。胃手术影响慢波传导，可能导致术后胃功能障碍。然而，胃切割对慢波的影响尚未得到全面评价。本研究旨在通过应用高分辨率（HR）电标测和计算机模拟来确定手术切除对胃慢波的影响。接受胃刺激器植入术的患者（n=10）接受了全层吻合器切除术（25×15 mm，远端体）以进行组织学评价，使HR标测（256个电极; 36 cm 2）能够在切除部位上方和附近进行。一个基于生物药理学的双向耦合ICC网络的计算机模拟模型被开发并应用于研究潜在的传导机制和切除方向的重要性。正常胃慢波在胃腔内传播（3.0±0.2周/分）。切除引起完全传导阻滞，小波围绕传导阻滞旋转，然后快速向传导阻滞远端周向传播（8.5±1.2 vs正常3.6±0.4 mm s-1; p<0.01）。这种“传导各向异性”稳态恢复了切除远端的顺行传播胃波前。切除术与5例患者的复杂心律失常相关：逆行传导（3/10）、异位（3/10）、功能阻滞（2/10）和碰撞（1/10）。模拟表明，传导各向异性出现从ICC层内的双向耦合，并显示横向切口长度和方向相关的传导失真的程度。在胃纵轴上定向切口对电传导和运动的破坏最小。然而，如果进行横向切口，胃传导各向异性的稳态机制通过恢复流产传播的波前进行补偿。复杂的心律失常伴随切除术可能会改变易感患者的术后恢复。
Gastric contractions are coordinated by slow waves, generated by interstitial cells of Cajal (ICC). Gastric surgery affects slow wave conduction, potentially contributing to post-operative gastric dysfunction. However, the impact of gastric cuts on slow waves has not been comprehensively evaluated. This study aimed to define consequences of surgical excisions on gastric slow waves by applying high-resolution (HR) electrical mapping and in-silico modeling. Patients undergoing gastric stimulator implantation (n=10) underwent full-thickness stapled excisions (25×15 mm, distal corpus) for histological evaluation, enabling HR mapping (256 electrodes; 36cm2) over and adjacent to excisions. A biophysically-based in-silico model of bi-directionally coupled ICC networks was developed and applied to investigate the underlying conduction mechanisms and importance of excision orientation. Normal gastric slow waves propagated aborally (3.0±0.2 cycles/min). Excisions induced complete conduction block and wavelets that rotated around blocks, then propagated rapidly circumferentially distal to blocks (8.5±1.2 vs normal 3.6±0.4 mm s−1; p<0.01). This ‘conduction anisotropy’ homeostatically restored antegrade propagating gastric wavefronts distal to excisions. Excisions were associated with complex dysrhythmias in 5 patients: retrograde propagation (3/10), ectopics (3/10), functional blocks (2/10) and collisions (1/10). Simulations demonstrated conduction anisotropy emerged from bidirectional coupling within ICC layers and showed transverse incision length and orientation correlated to degree of conduction distortion. Orienting incisions in the longitudinal gastric axis causes least disruption to electrical conduction and motility. However, if transverse incisions are made, a homeostatic mechanism of gastric conduction anisotropy compensates by restoring aborally-propagating wavefronts. Complex dysrhythmias accompanying excisions could modify post-operative recovery in susceptible patients.