NEW OPERATIVE PROCEDURE TO IMPROVE DIARRHEA AFTER TOTAL COLECTOMY

我们研究了回空肠转位术（IJT）对胃肠动力的影响以及IJT在结肠切除术后顽固性腹泻中的可能应用。在狗的实验中，我们将狗分为3组：对照组（不手术）。IJT（全结肠切除术+远端回肠等蠕动插入近端空肠）和假手术（结肠切除术+横断和再吻合）。采用“绝对重量法”分别测定胃固体和液体排空，同时测定血浆肽YY（PYY）水平。因此，两组之间液体的胃排空没有差异。与其他两组相比，IJT的固体胃排空延迟，血浆PYY升高。因此，认为血浆PYY升高导致IJT胃排空延迟。比较各组粪便含水量和粪便性状，发现IJT组粪便含水量显著低于假手术组。在大鼠实验中，我们也准备了3组（对照组、IJT组和假手术组），如在狗实验中一样。术后17-20周处死大鼠，取出回肠末端。制备纵行平滑肌条，在组织室中测量等长张力。结果，与对照组相比，IJT在没有任何刺激的情况下的基础自发收缩活动减少，并且在IJT中观察到对胆碱能激动剂氨甲酰胆碱的超敏反应。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两组之间没有差异。这些结果揭示了IJT对回肠平滑肌收缩力的影响，并提示IJT可能改善结肠切除术后腹泻。

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.