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

[在大鼠中]我们检测了全直结肠切除术（TPC）后小肠黏膜和肾脏中醛固酮功能及其基因诱导的相关功能。在正常大鼠TPC后，给药醛固酮可引起阿米洛利敏感短路电流（Isc），而正常大鼠则无此反应。在小肠下部，TPC诱导调节醛固酮功能的11β -羟基类固醇脱氢酶2型（11β - HSD2）的激活，以及阿米洛利敏感上皮Na+通道（ENaC）亚基mRNA的α。在肾脏中，TPC后ENaC的1113 HSD2、α β γ亚基mRNA和Na+-K+ ATPase的1beta1亚基mRNA均增强。我们认为高醛固酮分泌是全直结肠切除术后水电解质平衡调节的重要机制。[在狗]回肠制动，上消化道运动被抑制的营养物质（脂肪，葡萄糖等）输注到回肠，已经得到了很好的认识。我们设想了回空肠转位（IJT）模型，这是一种可能的手术程序来修改这一机制。我们研究了IJT对正常和完全集肠狗的运动和运输的影响。在正常犬中，IJT抑制餐后胃运动并延迟胃排空。IJT组血浆肠高血糖素（EG）、多肽YY（PYY）水平升高。在结肠切除的狗中，IJT延迟了胃排空，减少了粪便的含水量。我们认为，IJT可能是一种新的手术方式，可以抑制上消化道运动，改善全直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.