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

全结肠切除术后回肠储库的适应机制及影响研究

基本信息

批准号：
06671320
负责人：
KOH Kenzo
金额：
$ 0.96万
依托单位：
Kinki 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：
1994
资助国家：
日本
起止时间：
1994 至 1995
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-06671320/
关键词：
total colectomy J-pouch reservoir postperative adaptation bowel function luctulose hydrogen breath test intestinal transit time PYY colonization J pouch reservon 胃排出能 Lactulose-hydrogen breath test GLI 回腸嚢嫌気性菌 HBT

项目摘要

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.

在一项临床研究中，我们检查了14例全结肠切除术后患者的肠功能和乳果糖氢呼气试验的临床评估。回肠造口闭合后一年内所有患者的功能均“差”，且未显示氢呼吸气体浓度增加。12例术后1年以上患者中10例出现氢呼气浓度升高，其中8例功能“可”。肠道传输时间（TT）差组明显短于一般组和对照组（P<0.05）。在实验研究中，我们在腹膜反射上方3cm处切除全结肠和直肠，然后行端端吻合（E-E ; n = 5）或J-袋吻合（J-P ; n=5）。全结肠切除术后6个月，在透视下用应变式力传感器记录胃肠动力和钡餐通过时间。然后，用苏木精-伊红和抗PYY免疫组织化学染色观察J-P和E-E组与对照组（正常回肠; n=5）切除回肠的组织学变化。消化间期移行复合体（IMC）的增殖率在J-P组（64.8 × 3.2%）显著低于E-E组（98.6 × 1.2%）（p<0.001）。E-E的TT（138*10 min）比J-P（189*26 min）短（p<0.05）。绒毛长度无明显差异，但J-P的隐窝长度（0.59 × 0.08 mm）明显长于E-E（0.27 × 0.09 mm）和正常回肠（0.34 × 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），表明J-P组PYY阳性细胞的增加抑制了胃肠运动和转运。延迟的通过时间和隐窝的延长使肠道适应性增强，从而有助于管腔内容物的吸收。因此，J型贮袋在全结肠切除术后的回直肠吻合术中具有优势。