Kalff J C, Buchholz B M, Eskandari M K, Hierholzer C, Schraut W H, Simmons R L, Bauer A J
Department of Surgery, University of Pittsburgh Medical Center, Pa., USA.
Surgery. 1999 Sep;126(3):498-509.
Surgical manipulation of the intestine results in the massive movement of leukocytes into the intestinal muscularis at 24 hours. This is associated with muscle inhibition. The aim of this study was to temporally associate leukocyte extravasation with ileus after surgical manipulation.
Rats underwent a simple manipulation of the small bowel and were killed at various times (0, 0.25, 0.5, 1, 3, 6, 12, and 24 hours) postoperatively. Jejunal circular-muscle contractile activity was assessed in a standard organ bath. Both extravasating and resident leukocytes were immunohistochemically stained in muscularis whole mounts.
Contractile activity was significantly reduced immediately after surgery, but rapidly returned to control levels at 3 hours. After recovery, muscle function decreased at 12 and 24 hours (41% and 81%, respectively). The resident muscularis macrophage network demonstrated cellular activation 1 hour postoperatively. The number of leukocytes increased over time (neutrophils, 67.5-fold; monocytes, 98.2-fold; and mast cells, 47-fold at 24 hours).
The functional results demonstrate a biphasic response in the suppression of muscle activity after surgical manipulation. Regression analysis (r2 = 0.998) of the temporal development of leukocyte infiltration and the protracted phase of muscle inhibition provides evidence for a correlation between cellular inflammation and postoperative dysmotility.
肠道手术操作会导致白细胞在24小时时大量迁移至肠肌层。这与肌肉抑制有关。本研究的目的是在时间上关联手术操作后白细胞渗出与肠梗阻。
对大鼠进行小肠简单操作，并在术后不同时间点（0、0.25、0.5、1、3、6、12和24小时）处死。在标准器官浴槽中评估空肠环行肌收缩活性。对肌层整装片中外渗和驻留的白细胞进行免疫组织化学染色。
术后收缩活性立即显著降低，但在3小时时迅速恢复至对照水平。恢复后，肌肉功能在12小时和24小时时下降（分别为41%和81%）。驻留的肌层巨噬细胞网络在术后1小时显示细胞活化。白细胞数量随时间增加（24小时时，中性粒细胞增加67.5倍；单核细胞增加98.2倍；肥大细胞增加47倍）。
功能结果表明手术操作后肌肉活动抑制存在双相反应。对白细胞浸润的时间发展和肌肉抑制的延长阶段进行回归分析（r2 = 0.998），为细胞炎症与术后运动障碍之间的相关性提供了证据。
