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Early Postoperative Oral Intake Accelerates Upper Gastrointestinal Anastomotic Healing : Its underlying mechanism and clinical application

术后早期口服加速上消化道吻合口愈合：其机制及临床应用

基本信息

批准号：
20591541
负责人：
TERASHIMA Hideo
金额：
$ 3万
依托单位：
University of Tsukuba
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2008
资助国家：
日本
起止时间：
2008 至 2010
项目状态：
已结题

项目摘要

Basic research : In our previous study, we reported that early postoperative oral feeding accelerated upper gastrointestinal anastomotic healing in rats. To investigate its underlying mechanism, we performed in vivo and in vitro experiments. Rats that received proximal jejunal anastomosis were divided into four groups: the enteral nutrition (EN) group were fed via gastrostomy, the total parental nutrition (TPN alone) group were fed via a venous catheter, the TPN + saline group received an additional administration of normal saline solution via gastrostomy, and the TPN + water group received an additional administration of distilled water via gastrostomy. The anastomotic bursting pressure (ABP) and the hydroxyproline content of the anastomotic tissue were measured 5 d postoperatively. In an in vitro setting, the rat gastrointestinal fibroblasts were subjected to uniaxial stretching for 60 min, and the expression of type I and type III collagen mRNA was evaluated. The ABP and hydroxyprol … More ine content in the EN group, the TPN + saline group, and the TPN + water group were significantly higher than those in the TPN alone group. The mRNA levels of type I and type III collagen were increased by stretch stimulation. In addition, the expression of ERK, AKT, STAT3 and p38 MAPK was significantly observed. These results suggest that mechanical loading plays a key role in anastomotic healing. Collaterally, we examined the effects of platelet-rich plasma (PRP) on intestinal anastomotic healing because platelet is regarded as a storage vehicle of growth factors and plays a key role in the early phase of intestinal anastomotic healing. As a result, PRP might exert positive effects on intestinal anastomotic healing in a dose-dependent manner up to a certain level, but adverse effects occur when it is highly concentrated (bimodal effect). The essential PRP action appears to be driven by the platelets themselves.Clinical application : Based on above-mentioned studies, we delivered the following vision for clinical practice. Provided that anastomosis has been performed correctly, early postoperative oral intake after upper gastrointestinal anastomosis does not have a negative impact on anastomotic wound healing. There is a strong probability that early postoperative oral liquid intake accelerates upper gastrointestinal anastomotic healing compared with parenteral nutrition with a fasting period. We proposed that it is time to consider abolishing a period of starvation after upper gastrointestinal surgery. So, we demonstrated that postoperative early oral intake is feasible and safe as well as the experimental setting reported by us, also in an upper gastrointestinal operation with the high degree of surgical stress such as esophagectomy. Less

基础研究：在我们之前的研究中，我们报道了术后早期口服喂养促进大鼠上消化道吻合口愈合。为了研究其潜在的机制，我们进行了体内和体外实验。采用近端空肠吻合术的大鼠分为四组：肠内营养（EN）组经胃造口喂养，全亲代营养（TPN）组经静脉导管喂养，TPN +生理盐水组经胃造口加生理盐水，TPN +水组经胃造口加蒸馏水。术后5 d测定吻合口破裂压（ABP）和吻合口组织羟脯氨酸含量。体外培养大鼠胃肠道成纤维细胞，单轴拉伸60 min，检测I型和III型胶原mRNA的表达。EN组、TPN +生理盐水组和TPN +水组ABP和hydroxyprol . line含量均显著高于单独TPN组。牵张刺激使ⅰ型和ⅲ型胶原mRNA水平升高。此外，ERK、AKT、STAT3和p38 MAPK的表达均显著升高。这些结果表明机械负荷在吻合口愈合中起关键作用。此外，我们研究了富血小板血浆（PRP）对肠吻合口愈合的影响，因为血小板被认为是生长因子的储存载体，在肠吻合口愈合的早期阶段起着关键作用。因此，PRP可能在一定程度上呈剂量依赖关系，对肠吻合口愈合有积极作用，但浓度过高时出现不良反应（双峰效应）。基本的PRP作用似乎是由血小板本身驱动的。临床应用：基于上述研究，我们提出了以下临床实践愿景。在吻合正确的情况下，上胃肠道吻合术后早期口服摄入对吻合口伤口愈合没有负面影响。术后早期口服液体摄入比空腹肠外营养更有可能加速上消化道吻合口愈合。我们建议是时候考虑取消上消化道手术后的一段时间的饥饿。因此，我们证明了术后早期口服摄食是可行和安全的，以及我们报道的实验设置，同样适用于手术应激程度较高的上消化道手术，如食管切除术。少