NEW OPERATIVE PROCEDURE TO IMPROVE DIARRHEA AFTER TOTAL COLECTOMY

我们研究了回肠空肠移位术(IJT)对胃肠动力的影响，以及IJT治疗难治性结肠切除术后腹泻的可能性。在狗身上的实验中，我们将狗分为3组：对照组(不做手术)。IJT(全结肠切除、回肠远端等蠕动间置于近端空肠)和SHAM(结肠切除横断吻合术)。采用绝对重量法分别测定固体和液体胃排空，同时测定血浆多肽YY(PYY)水平。因此，液体的胃排空在不同组之间没有差异。与其他2组比较，IJT组固体胃排空延迟，血浆PYY升高。因此，血浆PYY升高被认为是导致IJT胃排空延迟的原因。比较各组大鼠粪便含水率和粪便性质，发现IJT组大鼠粪便含水率明显低于假手术组。在大鼠实验中，我们还准备了3个组(对照组、IJT和Sham)，与狗的实验相同。术后17-20周处死大鼠，取出远端回肠。制备纵向肌条，在组织腔内测量等长张力。结果显示，与对照组相比，IJT组在无任何刺激的情况下基础自发收缩活动减少，并且对胆碱能激动剂Be-ecol有超敏反应。我们还发现，对肾上腺素能激动剂去甲肾上腺素的敏感性和对电场刺激的反应在不同组之间没有差异。这些结果揭示了IJT对回肠平滑肌收缩功能的影响，提示IJT有改善结肠切除术后腹泻的可能性。

We studied the effect of ileo-jejunal transposition (IJT) on gastrointestinal motility and the possible application of IJT to intractable post-colectomy diarrhea. In experiments with dogs, we divided dogs into 3 groups; control (no surgery). IJT (total colectomy + isoperistaltic interposition of the distal ileum into the proximal jejunum), and sham (colectomy + transection & reanastomosis). We measured gastric emptying of solid and liquid separately with 'absolute weight method,' and plasma level of peptide YY (PYY) was measured at the same time. As a result, gastric emptying of the liquid was not different between groups. Gastric emptying of the solid was delayed and plasma PYY was increased in IJT compared to the other 2 groups. Therefore, enhanced plasma PYY was considered to have induced delayed gastric emptying in IJT. We compared fecal water content and character of feces among groups and found that fecal water content in IJT was significantly less than that in sham. In experiments with rats, we also prepared 3 groups (controll, IJT, and sham) as in experiments with dogs. We killed rats 17-20 weeks after the operation and took out the distal ileum. Longitudinal smooth muscle strips were prepared, and isometric tension was measured in tissue chamber. As a result, basal spontaneous contractile activity without any stimulus was decreased in IJT compared to control, and hypersensitivity to cholinergic agonist bethanechol was observed in IJT. We also found that sensitivity to adrenergic agonist norepinephrine and response to electrical field stimulation did not differ between groups. These results revealed the effect of IJT on ileal smooth muscle contractility and suggested the possibility the IJT could improve post-colectomy diarrhea.