小肠移植后淋巴管重建促进移植肠对血浆游离脂肪酸吸收(英文)

Improvement of free fatty acid absorption of graft by lymphatic reconstruction after small bowel transplantation

目的 :研究异位双造口小肠移植 (SBT)后进行淋巴管重建 (lymphaticreconstruction ,LR)对移植肠脂肪酸吸收影响 .方法 :近交系雄性BrownNorway (BN)大鼠分为和BN→LEW +FK5 0 6 (n =12 )两组 .用气相色谱法测定大鼠SBT术前和术后 1,4 ,7,10和 14d血浆中游离脂肪酸 (FFAs)C14 ,C16,C18∶1,C18∶2 和C2 0∶4浓度 .结果 :在SBT后行立即淋巴管重建的大鼠 ,术后血浆FFAs浓度较未行淋巴管重建的SBT大鼠血浆FFAs浓度显著高 ,特别是在术后早期 (7d内 ) ,而术后早期对于移植物和受体机体及肠功能的恢复是关键的 .在10～ 14d后 ,两组动物血浆FFAs的浓度趋向接近 ,可能为此时未行淋巴管重建大鼠移植物淋巴管网较多侧枝代偿性建立有关 ,但其血浆FFAs的浓度仍低于淋巴管重建大鼠 .结论 :SBT后行立即淋巴管重建、早期肠内营养 ,可为机体提供充分的能量 ,有效地纠正低血浆FFAs,防止SBT后早期必需脂肪酸的缺乏 。

AIM: To investigate the effects of immediate reconstruction of lymphatic drainage of the graft after small bowel transplantation (SBT) and early enteral nutrition (EN) support on plasma level of free fatty acids (FFAs) using a model of lymphatic reconstruction (LR) after SBT. METHODS: Male Brown Norway (BN) and Lewis (LEW) rats were divided into two groups: Group A (LR group), BN→LEW+LR+FK506 ( n =12), group B (non LR group), BN→LEW+FK506 ( n =12). The levels of FFAs, including C 14 , C 16 , C 18∶1 , C 18∶2 and C 20∶4 in plasma were measured with gas chromatography preoperation and on day 1, 4, 7, 10 and 14 post operation. RESULTS: The postoperation plasma concentrations of FFAs C 14 , C 16 , C 18∶1 , C 18∶2 and C 20∶4 in LR group were higher than those in non LR group, especially during the early 7 days, which was important for the gut physiological functions of allograft and the host. 10 to 14 days after operation, although the concentrations of plasma FFAs in the 2 groups were getting closer, the concentration of plasma FFAs in non LR group was lower than that in LR group, possibly because of the morphological regeneration of lymphatic drainage through small collateral vessels. CONCLUSION: Immediate reconstruction of lymphatic drainage of the graft after SBT and early EN support will provide sufficient energy, correct the low plasma FFAs, and prevent FFAs deficiency after SBT.