FACTORS INITIATING POSTOPERATIVE ILEUS

拟议研究的目标是确定以下因素 术后短暂性肠梗阻的发生 剖腹术。术后肠梗阻是重要患者的责任 腹部手术后的不适和延长住院时间 手术，因此产生了重要的医疗和经济后果。 确定引发术后肠梗阻的因素是必不可少的一步。 了解这一过程的病理生理学。到目前为止 这些因素是未知的。 近年来腹腔镜术在腹部手术中的应用 与观察到的严重程度显著下降有关 以及术后疼痛和肠梗阻的持续时间 程序。这项拟议的研究将量化肠梗阻的程度。 腹腔镜手术后，并与类似的开腹手术进行比较 腹部手术。胃肠道肌电的测定 活动将是用于量化运动性的主要参数， 压力探头，放射性核素排空研究的数据证实， 和凌日研究。可能引发手术后的个体因素 肠梗阻，尤其是那些导致创伤和术后增加的肠梗阻 疼痛，将以受控方式进行研究，以确定它们的 对这一进程的贡献。这些因素将包括大小和深度 腹壁切开，肠或肠系膜操作， 手术环境温度，肠道或内脏切割， 以及循环中的加压素、化学物质的系统过程 腹膜炎和细菌性腹膜炎。人类受试者将被用于 这项研究是适当和可行的。研究中需要的部分 更广泛的操作将使用狗。 应明确术后肠梗阻的诱发因素 以前提出但未得到确认的机制，通过这些机制， 也许还有其他更持久的病理生理学疾病 胃肠运动，都是受调节的。对这种机制的了解是 需要指导对这些疾病进行适当的未来治疗。

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.