大鼠回肠J型储袋肛管吻合模型的建立及优化

Establishment and Optimization of a Rat Model of Ileal J Pouch–Anal Anastomosis

目的:优化大鼠储袋炎模型制作工序,制定相关指标量化标准,创新吻合方式,提高储袋制作成功率,为术后储袋相关疾病如储袋炎与肠道微生态关系的基础研究搭建有力平台。方法:选取重量为300~350 g雄性Sprague-Dawley大鼠,行全结直肠切除回肠J型储袋肛管吻合术,待建模技术稳定后,选取20只大鼠,随机分为两组,一组为非手术组(n=10),另一组为手术组(n=10)。术后比较两组大鼠体重、粪便变化,储袋术前术后尺寸,显微病理结构等改变,结合相关文献分析比较改变吻合方式后手术时间及存活率变化。结果:改变吻合方式后建模时间缩短至约40 min,术后长期存活率>80%。术后5周内,手术组第1周体重平均减轻(42.0±1.2)g,且体重降至最低水平,而后4周,每周平均体重增加是(19.6±1.4)g、(44.0±1.2)g、(46.2±2.2)g及(33.1±2.1)g,术后15~21 d恢复至术前体重,手术组与对照组术后1到5周体重对比有显著差异(P<0.05)。IPAA组术后第1~5周粪便评分分别为(1.3±0.5)、(2.5±0.5)、(3.8±0.5)、(4.0±0.0)、(4.0±0.0),术后第1~3周评分与术前评分相比均具有明显的差异(P<0.05)。术中、术后5周储袋容积分别为(2.7±0.1)cm3和(4.8±0.4)cm3,后者是前者的是1.8倍,体积有显著增加(P<0.001)。病理结果示储袋黏膜绒毛钝化变矮融合,潘氏细胞减少,肠壁肌层增厚,而对照组末端回肠黏膜未见异常。结论:通过改变吻合方式、术后护理方法,优化制作流程,有效缩短了手术时间,提高了建模成功率。

Objective： To optimize the generation of the rat model of ileal J pouch–anal anastomosis and to establish the quantitative standard of related indicators and the innovative anastomosing method to improve the success rate of pouch production. To build a powerful platform for basic research in the field of pouch and intestinal microecology. Method： Ileal pouch anal anastomosis was performed in male Sprague-Dawley rats weighing between 300 and 350 g. After modeling technology stabled, 20 rats were enrolled and randomly divided into nonsurgical group（n = 10） and surgical group（n = 10）. Changes of weight and feces, size of pouch before and after operation, operation time and survival rate after the change of the anastomosis type were compared. Ileal pouch specimens of IPAA group and terminal ileum specimens of control group were obtained for histological assessment. Results： Model establishment requires 40 minutes. The overall survival rate is 80%. In surgery group, the average weight losses were（42.0 ± 1.2） g,（19.6 ± 1.4） g,（44.0 ± 1.2） g,（46.2 ± 2.2） g and（33.1 ± 2.1） g within the first week and the next four weeks, respectively. There was significant difference in weight between surgical and nonsurgical group within 5 weeks after operation（P〈0.05）. The fecal scores of IPAA group were（1.3 ± 0.5）,（2.5 ± 0.5）,（3.8 ± 0.5）,（4.0 ± 0.0） and（4.0 ± 0.0）, respectively. There was a significant difference between postoperative score within the first 3 weeks and the preoperative score（P〈0.05）. The pouch volumes of intraoperative period and 5 th week after operation were（2.7 ± 0.1） cm3 and（4.8 ± 0.4） cm3. The latter is 1.8 times larger than the former. There was a significant increase in volume（P〈0.001）. Histological results showed villous shortening, reduced Paneth cells and intestinal wall muscle thickening in ileal pouch mucosa, compared to normal mucosa in terminal ileum specimens of control group. Conclusion： By changing the way of anastomosis, postoperative nursing method and optimizing the production process, the operation time was shortened effectively, and the success rate was improved.