全胃切除术后不同消化道重建方式对比格犬小肠动力影响的机制研究

Mechanism study on intestinal motility of reconstruction procedures after total gastrectomy

目的研究全胃切除术后不同消化道重建术式对犬小肠动力的影响。方法将13只比格犬分为对照组（3只，仅行假手术），全胃切除后采用功能性间置空肠进行消化道重建（FJI组，7只）和全胃切除后采用Roux-en-Y吻合进行消化道重建（RY组，3只）。手术后48h处死比格犬。处死前1h灌人活性炭，检测小肠转运率。取吻合口上下5cm的小肠，分别应用苏木精一伊红染色、免疫组织化学染色和干涉显微镜观察和检测小肠炎性反应，小肠组织卡哈尔细胞（ICC）分布及上皮凋亡情况。结果对照组和FJI组的小肠转运率分别为0．14±0．03和0．32±0．11，显著低于RY组（0．52±0．21，P〈0．05）。FJI组较RY组的小肠分布更多的ICC；FJI组的小肠浆膜炎性反应（包括出血、纤维渗出、溃疡）、中性粒细胞和巨噬细胞浸润以及小肠上皮细胞凋亡情况均不如RY组明显。结论减少手术创伤、保持小肠连续性的功能性间置空肠吻合消化道重建方式，具有更好的食物储存功能，有利于术后小肠动力的恢复。

Objective To investigate the mechanism of reconstruction procedures affecting intestinal motility after total gastrectomy. Methods Beagle dogs were divided into 3 groups：3 dogs in sham operation group, 7 in functional jejunal interposition （FJI）group, and 3 in Roux-en Y（RY） group. These dogs were sacrificed 48 hours postoperatively. Dogs were garaged with active carbon 1 h before sacrifice and the intestinal transit rate was evaluated. Intestinal tissues 5 cm away from the duodenojejunal anastomosis were collected for detecting inflammation, ,interstitial cells of Cajal （ICC）, and apoptosis using HE staining, immunohistochemistry, and interference microscope respectively. Results The intestinal transit rate in sham and FJI group （0.14±0.03 and 0.32±0.11） was lower than that in RY group（0.52±.21, P〈0.05）, which indicated FJI procedure had better food storage. More ICCs were found in submucosa of FJI group than those of PLY group. Inflammation in serosal side of the intestine, including hemorrhage, fibrin deposition, and ulceration, neutrophil and macrophage infiltration, and intestinal epithelial cell apoptosis were significantly reduced in FJI group as compared to RY group, which indicated that amelioration of intestinal inflammation and damage might contribute to reducing ICC loss in FJI group. Conclusions As a reconstruction procedure with less traumatic and intestinal continuity preserving, FJI has better reservoir function and quicker recovery of intestinal motility.