Therapeutic strategy for patients after total excision of large bowel based on pathophysiological mechanism (Establishment of postoperative management after total colectomy).

[In本研究检测了全结肠直肠切除术（TPC）后小肠粘膜和肾脏中醛固酮功能及其相关基因的表达。在正常大鼠中，未观察到阿米洛利敏感性短路电流（Isc）。在小肠下部，TPC诱导11 β羟基类固醇脱氢酶2型（11 β HSD 2）的激活，其调节醛固酮和阿米洛利敏感性上皮Na+通道（ENaC）的α亚基mRNA的功能。肾组织中1113 HSD 2、ENaC α β γ亚单位mRNA和Na+-K+ ATP酶α 1 β 1亚单位mRNA表达在TPC后明显增强。提示高醛固酮血症是全结肠切除术后水电解质平衡调节的重要机制。[In回肠制动，即上消化道运动被营养物（脂肪、葡萄糖等）输注到回肠中而受到抑制，已经被广泛认识。我们设想了回肠-空肠转位（IJT）模型，这是一种可能的手术方法来修改这一机制。本实验观察了IJT对正常或全结肠切除犬的运动和转运的影响。在正常犬中，IJT抑制餐后胃运动和延迟胃排空。IJT组血浆肠胰高血糖素（EG）和肽YY（PYY）水平升高。在结肠切除的狗，IJT延迟胃排空和减少粪便的含水量。结论：IJT可能是一种新的手术方法，它可以抑制上消化道动力，提高全直肠结肠切除术患者的生活质量。

[In Rats] We examined function and gene induction relating to the function of aldosteron in small intestinal mucosa and kidney after total proctocolectomy(TPC). Adimnistration of aldosteron evoked amiloride-sensitive short circuit current(Isc) after TPC, otherwise no response of Isc was observed in normal rats. In lower small intestine, TPC induced the activation of 11beta hydroxysteroid dehydrogenase type 2(11beta HSD2) which regulates the function of aldosteron, and alpha, subunit mRNA of amiloride-sensitive epithelial Na+ channel(ENaC). In kidney, 1113 HSD2, alpha beta gamma subunit mRNA of ENaC, and a 1beta1 subunit mRNA of Na+-K+ ATPase were enhanced after TPC.We concluded that hyperaldosteronism is a very important mechanism for the regulation of water and electrolyte balance after total proctocolectomy.[In dogs] Ileal brake, that upper gastrointestinal motility was suppressed by the infusion of nutrients(fat, glucose, etc) into the ileum, has been well recognized. We have conceived the model of Ileo-jejunal transposition(IJT) which is a possible operative procedure to modify this mechanism. We examined the effect of IJT on the motility and transit in normal or totally colectomized dogs. In normal dogs, IJT suppressed postprandial gastric motility and delayed gastric emptying. Plasma enteroglucagon(EG) and Peptide YY(PYY) level were increased in IJT group. In colectomized dogs, IJT delayed gastric emptying and reduced water content of the stool. We conclude that IJT may be a novel operative procedure, which can suppress the upper gastrointestinal motility and improve the quality of life in patients who received total proctocolectomy.