FACTORS INITIATING POSTOPERATIVE ILEUS

拟议研究的目标是确定 导致术后短暂性肠梗阻 剖腹术 术后肠梗阻是导致严重患者 腹部手术后的不适和住院时间延长 手术，因此具有重要的医疗和经济后果。 明确术后肠梗阻的发病因素是预防术后肠梗阻的关键 了解这个过程的病理生理学。 为了确定这些 因素未知。 腹腔镜技术在腹部手术中的应用 与观察到的严重程度显著降低有关 和术后疼痛和肠梗阻的持续时间 程序. 拟议的研究将量化肠梗阻的程度 腹腔镜手术后，并将其与类似的开放手术进行比较， 腹部手术 胃肠肌电测量 活性将是用于定量运动性的主要参数， 通过压力探头、放射性核素排空研究 和过境研究。可能引发术后并发症的个体因素 肠梗阻，特别是那些导致创伤和术后 疼痛，将以受控的方式进行研究，以确定其 对进程的贡献。 这些因素将包括 腹壁切口，肠或肠肠系膜操作， 手术环境的温度，肠道或内脏切割， 以及循环血管加压素、化学物质 腹膜炎和细菌性腹膜炎。 人类受试者将用于 研究是适当和可行的。 研究的那些部分需要 更广泛的操作将使用狗。 应明确引起术后肠梗阻的因素 以前提出但未经证实的机制， 也许还有其他更持久的病理生理疾病， 胃肠道运动，是介导的。 了解这些机制是 需要指导这些疾病的适当未来治疗。

The objectives of the proposed research are to define factors that contribute to the initiation of transient postoperative ileus following celiotomy. Postoperative ileus is responsible for significant patient discomfort and prolongation of hospitalization following abdominal surgery, and as such has important medical and economic consequences. Defining the factors initiating postoperative ileus is an essential step in understanding the pathophysiology of this process. To date these factors are unknown. The recent use of laparoscopic techniques to perform abdominal operations has been associated with the observation of a marked decrease in severity and duration of postoperative pain and ileus in patients undergoing such procedures. The proposed research will quantitate the degree of ileus following laparoscopic surgical procedures, and compare it to similar open abdominal procedures. Measurement of gastrointestinal myoelectric activity will be the main parameter used to quantitate motility, with confirmation by data from pressure probes, radionuclide emptying studies, and transit studies. Individual factors likely to initiate postoperative ileus, especially those which result in increased trauma and postoperative pain, will be studied in a controlled fashion to determine their contributions to the process. Such factors will include size and depth of abdominal wall incision, bowel or bowel mesentery manipulation, temperature of the operative environment, intestinal or visceral cutting, and the systemic processes of circulating vasopressin, chemical peritonitis, and bacterial peritonitis. Human subjects will be used in the study as appropriate and feasible. Those parts of the study requiring more extensive manipulations will use dogs. Identification of factors initiating postoperative ileus should clarify previously proposed but not confirmed mechanisms by which this process, and perhaps other more sustained pathophysiologic diseases of gastrointestinal motility, are mediated. Knowledge of such mechanisms is needed to direct appropriate future therapy for these disorders.