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Basic and Clinical investigation for disordered defecation after low anterior resection

低位前切除术后排便障碍的基础与临床研究

基本信息

批准号：
05671073
负责人：
MIBU Ryuichi
金额：
$ 1.34万
依托单位：
KYUSHU UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1993
资助国家：
日本
起止时间：
1993 至 1994
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-05671073/
关键词：
colon rectum motility colectomy

项目摘要

After anterior resection of the rectum (AR) with lymph node dissection, change in bowel habit is often observed even after recovery of the anorectal function possibly due to changes in colonic motility after the operation. This study was to investigate the relationship between the degrees of extrinsic autonomic nerve injury and the changes in colonic motility. [Methods] Twelve mongrel dogs were equally divided into four groups and underwent implantation of 5 serosal electrodes on the colon. Group A had denervation of autonomic nerves in the paraaortic and presacral regions, including hypogastric nerve and pelvic plexus, from the level of the axis of the caudal mesenteric artery (CMA) to the pelvic space. Group B had denervation in the paraaortic region from the axis of the CMA to the bifurcation of the iliac artery. Group C had denervation by dividing the mesocolon along the marginal artery from the CMA to the peritoneal reflection. Group D had only electrode implantation. Electromyogr … More aphic activity was measured continuously during 30 minutes in interdigestive state and 120 minutes after injection of olive oil through gastrostomy. The number of continuous electrical response activity (CERA) and contractile electrical complex (CEC) were counted in every ten minutes. [Results] Three weeks after the operation, colonic CERA and CEC in the period from 20 to 30 and 30 to 40 minutes after the olive oil injection was smaller (p<0.05) in Group A (2.2<plus-minus>0.72,3.4<plus-minus>1.12, respectively ; mean<plus-minus>SEM) than in Group D(10.6<plus-minus>1.97,10.8<plus-minus>2.24). This difference was present even in the right-sided colon (Group A : 0.4<plus-minus>0.28,0.6<plus-minus>0.40 ; Group D : 4.3<plus-minus>0.98,4.3<plus-minus>0.91 ; p<0.05). On the other hands, CERA and CEC in the interdigestive state in Group B (8.8<plus-minus>1.87)and C(7.6<plus-minus>1.45) were increased (p<0.05) as compared with Group D (5.2<plus-minus>0.83).Four months after the operation, increased colonic motility in Group B and C returned to the level of Group D,but the low colonic motility was still observed in the right-sided colon in Group A (0.8<plus-minus>3.32,0.4<plus-minus>3.32 ; p<0.05). [Conclusions] Pelvic plexus plays an important role in colonic motility even of the right-sided colon. The damage to theparasympathetic presynaptic neurons did not recover at least until 4 months after denervation. These data suggest that the pelvic plexus injury may cause the change in bowel habit after AR Less

直肠前切除术合并淋巴结清扫术后，即使肛肠功能恢复，排便习惯也常发生改变，这可能是由于术后结肠动力的改变所致。本研究旨在探讨外源性自主神经损伤程度与结肠运动性变化的关系。[方法]12只杂种狗平均分为4组，在结肠上植入5个浆膜电极。A组从尾侧肠系膜动脉（CMA）轴线水平至盆腔间隙，腹下神经和盆腔丛等腹旁和骶前区自主神经去神经支配。B组从CMA轴至髂动脉分叉处的主动脉旁区无神经支配。C组通过沿边缘动脉从CMA到腹膜反射分离结肠系膜进行去神经支配。D组仅行电极植入。在消化间期30分钟和胃造口注射橄榄油后120分钟，连续测量肌电活动。每10分钟计数连续电反应活动（CERA）和收缩电复合体（CEC）的次数。[结果]术后3周，橄榄油注射后20 ~ 30分钟、30 ~ 40分钟，A组结肠CERA、CEC（分别为2.2<正负>0.72、3.4<正负>1.12，平均值<正负>SEM）均小于D组（10.6<正负>1.97、10.8<正负>2.24），差异有统计学意义（p<0.05）。这种差异甚至出现在右侧结肠（A组：0.4<正负>0.28,0.6<正负>0.40；D组：4.3<正负>0.98,4.3<正负>0.91,p<0.05）。B组消化间期CERA和CEC（8.8<正负>1.87）和C组（7.6<正负>1.45）较D组（5.2<正负>0.83）显著升高（p<0.05）。术后4个月，B组、C组结肠活动度升高，恢复到D组水平，但A组右侧结肠活动度仍较低（0.8<±>3.32,0.4<±>3.32,p<0.05）。[结论]盆腔丛在右侧结肠运动中起重要作用。副交感神经突触前神经元的损伤至少在去神经支配4个月后才恢复。这些数据提示盆腔神经丛损伤可能导致AR术后排便习惯的改变