实验性犬小肠梗阻的病理变化研究

Pathological research of experimental small bowel obstruction in dogs

目的:探讨犬急性小肠梗阻后不同时间手术松解对小肠黏膜屏障病理形态的影响。方法:40只实验用犬随机分为梗阻1组(n=9,梗阻72 h)、2组(n=9,梗阻120 h)、松解1组(n=9,梗阻72 h,松解梗阻120 h)、2组(n=9,梗阻120 h,松解梗阻120 h)和C组(n=4,假手术对照),分别制作低位回肠梗阻模型并按时松解梗阻,达规定时间各组分别获取梗阻两端肠壁组织行光学显微镜和透射电镜观察。结果:梗阻1组黏膜上皮水肿,炎细胞浸润,紧密连接轻度损伤。梗阻2组黏膜上皮损伤重,细胞间隙连接增宽,可见细菌进入。松解1组黏膜上皮细胞增生,紧密连接修复。松解2组黏膜下层淋巴滤泡增生,损伤上皮细胞抛出,连接复合体松散破坏,线粒体空泡化。结论:急性机械性肠梗阻导致肠黏膜屏障的损伤随缺血时间延长而加重,早期手术松解梗阻有利于小肠黏膜屏障结构及功能的修复。

Objective： To research the effects of adhesiolysis on pathomorphology at different time after acute experimental bowel obstruction. Methods： 40 dogs were divided into obstruction groups 1, 2, adhesiolysis groups 1, 2 and control group. Terminal ileum mechanical obstruction models were made in the four experimental groups. At 72 h and 120 h after obstruction, samples of intestinal wall of obstruction groups were obtained and examined by light and transmission electron microscopy; at the mean time laparotomy were performed on adhesiolysis groups, then samples were studied. Results： In obstruction group 1, mueosa were edema, and with an apparently inflammatory infiltration in both the mucosa and submucosa, minor injury were found on tight junction. In adhesiolysis group 1, proliferation of epithelial cells and recovery of tight junction were found. In obstruction group 2, injury of epithelial was severe, gap junction was wider and bacteria can be seen in it. In adhesiolysis group 2, lymph foilicie hyperplasia was found in submucosa, damaged epithelial cells were thrown out, junctional complex were loosen and mitochondrion became vacuolization. Conclusion： Acute mechanical bowel obstruction may induced intestine barrier injury, which became more severe follow by delayed of ischemia. Early adhesiolysis may profit to repair the mucosal barrier of small intestine.