Studies on adaptation mechanism and effects of ileal reservoir following total colectomy

在一项临床研究中，我们检查了14例全结肠切除术后肠功能和乳果糖氢呼吸试验的临床评估。所有患者在回肠造口术后1年内功能“差”，呼吸氢气浓度无增加。12例1年以上患者中有10例出现呼吸氢气浓度增高，8例功能“一般”。“差”组肠道转运时间（TT）短于“好”组和对照组（p<0.05）。呼气中氢气的增加提示回肠菌群和定植的改变。在实验研究中，我们在腹膜反射上方3cm的直肠切除后进行端对端（E-E; n-5）或j -袋（J-P; n=5）吻合。在全结肠切除术后6个月，用应变式力传感器和在透视下用钡餐记录胃肠运动时间。然后用苏木精-伊红和抗pyy免疫组化染色检测J-P和E-E切除回肠与对照组（正常回肠，n=5）的组织学变化。消化间迁移复群繁殖率（IMC）在J-P组（64.8*3.2%）显著低于E-E组（98.6*1.2%）（p< 0.01）。E-E组TT （138*10 min）短于J-P组（189*26 min） （p< 0.05）。J-P组绒毛长度无显著差异，但隐窝长度（0.59*0.08 mm）明显长于E-E组（0.27*0.09 mm）和正常回肠组（034*0.07 mm） （p< 0.01）。J-P组PYY阳性细胞总数（168*18）显著高于E-E组（111*16）和对照组（103*14）（p< 0.05）。因此，j -袋中PYY阳性细胞的增加抑制了胃肠运动和转运。延迟转运时间和隐窝延长带来肠道适应，有助于肠道内容物的吸收。因此，提示j袋储存器在全结肠切除术后的回肠直结肠造口术中具有优势。

In a clinical study, we examined the clinical assessment of bowel function and lactulose hydrogen breath test in 14 patients after total colectomy. All patients within one year after ileostomy closure had 'poor' function and showed no increase of hydrogen breath gas concentration. 10 of 12 patients more than one year showed increase of hydrogen breath gas concentration, and 8 of them had 'fair' function. The intestinal transit time (TT) in 'poor' group was shorter than in 'fair' group and control (p<0.05). The increase of hydrogen breath gas suggests changes of bacterial flora and colonization of the ileum.In an experimental study, we performed end to end (E-E ; n-5) or J-pouch (J-P ; n=5) anastomosis after resection of tatal colon and the rectum 3 cm above the peritoneal reflexion. Gastrointestinal motility with strain gauge force transducers and transit time with barium meal under the fluoroscopy were recorded 6 months after total colectomy. Then, histological changes of resected ileum in J-P and E-E vs control (normal ileum ; n=5) were measured with hematoxylin-eosin and anti-PYY immunohistochemical stains. Propagation rate of interdigestive migrating complex (IMC) was significantly lower in J-P (64.8*3.2%) than in E-E (98.6*1.2%), (p<O.001). TT in E-E (138*10 min) was shorter (p<O.O5) than in J-P (189*26 min). There was no difference in length of villi but length of crypts in J-P (0.59*0.08 mm) was longer than that in E-E (0.27*0.09 mm) and normal ileum (034*0.07 mm) (p<O.O1). Total number of PYY postitve cells in J-P (168*18) was significantly increased than that in E-E (111*16) and control (103*14) (p<O.O5).Thus, increase of PYY positive cells in J-pouch inhibited gastrointestinal motility and transit. Delayed transit time and crypts elongation braught intestinal adaptation that assists the absorption of luminal contents. Therefore, it suggested that J-pouch reservoir had advantage to ileo-proctostomy following total colectomy.