全胃切除消化道重建的动物实验研究

Study on Reconstruction of Digestive Tract Following Total Gastrectomy in Rats

目的通过建立大鼠全胃切除模型,探讨全胃切除术后合理的消化道重建方式。方法SD雄性大鼠60只,随机均分为Roux-en-Y组(RY组)、近端空肠储袋组(PJP组)、远端空肠储袋组(DJP组)、双空肠储袋组(TJP组)、十二指肠空肠储袋间置组(DJPI组)和剖腹探查组(L组)6组,观察和比较术后大鼠体重、肠道排空距离、食管空肠吻合口黏膜病理改变以及小肠黏膜形态学变化。结果各组术后2周大鼠体重均较术前明显减轻(P<0.05),术后第4周及8周体重开始逐渐恢复,PJP组、TJP组和DJPI组均较RY组恢复好(P<0.05)。PJP组与RY组相比,肠道排空距离缩短,排空减慢(P<0.05)。在小肠黏膜形态改变方面,TJP组和DJPI组与RY组间差异有统计学意义(P<0.05)。在返流性食管炎方面各组间差异均无统计学意义(P>0.05)。结论近端和双空肠储袋吻合术是全胃切除后消化道重建的理想术式,十二指肠空肠储袋间置术也如此,但与前两者比无明显优势。

Objective To find out some ideal reconstructions after total gastrectomy in experimental study of rat. Methods Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups： Roux-en-Y group （RY group）, proximate jejunal pouch group （PJP group）, distal jejunal pouch group （DJP group）, two jejunal pouchs group （TJP group）, duodenum jejunal pouch interposition group （DJPI group） and laparotomy group （L group）. Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and mot phology changes of intestine after operation were observed and compared. Results At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P〈0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P〈0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P〈 0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P〈0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P〉0.05）. Conclusion Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.