Tsiotos G G, Kendrick M L, Libsch K, Bierens K, Lankisch P, Duenes J A, Sarr M G
Gastroenterology Research Unit and Department of Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905, U.S.A.
J Gastrointest Surg. 2001 Sep-Oct;5(5):517-24. doi: 10.1016/s1091-255x(01)80090-1.
Net absorption of water, electrolytes, and simple nutrients decreases early after jejunoileal autotransplantation (extrinsic denervation) in a canine model but recovers toward normal by 8 weeks. However, the ability of the extrinsically denervated ileum to adapt after total jejunectomy, which would be relevant as a model of segmental small bowel transplantation, remains unknown. Two groups of five dogs each were studied before and 2 weeks and 12 weeks after 50% proximal enterectomy. A control group remained neurally intact, whereas the other group underwent extrinsic denervation (Ext Den) of the remaining ileum. Using a perfusion technique, net absorption of water, electrolytes, and five simple nutrients (glucose, arginine, glutamine, and oleic and taurocholic acids) was measured at the three time points. Ileal morphometry was also evaluated. All dogs developed diarrhea, which resolved by 12 weeks in all but two of the Ext Den dogs. Weight in both groups was decreased at 2 weeks (P <0.05), returned to normal at 12 weeks in control dogs, but remained low in Ext Den dogs (P <0.05). Maximal weight loss was greater in the Ext Den group (P <0.05). No consistent or important differences in net absorptive fluxes of water, electrolytes, or simple nutrients were noted either within or between groups at any time point. Villous height, crypt depth, and longitudinal muscle width increased significantly at 12 weeks after jejunectomy in the Ext Den dogs, but not in the control dogs (P <0.05). Extrinsic denervation of the ileum results in persistent weight loss after proximal 50% enterectomy. Despite diarrhea, only minor changes in electrolyte absorption occur, and ileal net absorption of simple nutrients remains unaffected. The ileum of extrinsically denervated dogs undergoes a more prominent morphometric adaptation after jejunectomy. Extrinsic denervation necessitated by small bowel transplantation, independent of immune effects, does not appear to suppress the ileal adaptive response to maintain net absorption of water, electrolytes, and simple nutrients.
在犬类模型中，空肠回肠自体移植（去神经支配）后早期，水、电解质和简单营养物质的净吸收减少，但到8周时恢复正常。然而，作为节段性小肠移植模型，去神经支配的回肠在全空肠切除术后的适应能力仍不清楚。两组，每组五只狗，在50%近端肠切除术前、术后2周和12周进行研究。一组为神经完整的对照组，另一组对剩余回肠进行去神经支配（Ext Den）。采用灌注技术，在三个时间点测量水、电解质和五种简单营养物质（葡萄糖、精氨酸、谷氨酰胺、油酸和牛磺胆酸）的净吸收。还评估了回肠形态学。所有狗都出现腹泻，除两只Ext Den组狗外，所有狗的腹泻在12周时都得到缓解。两组狗的体重在2周时均下降（P<0.05），对照组狗在12周时恢复正常，但Ext Den组狗的体重仍较低（P<0.05）。Ext Den组的最大体重减轻更大（P<0.05）。在任何时间点，组内或组间在水、电解质或简单营养物质的净吸收通量方面均未发现一致或重要的差异。在Ext Den组狗中，空肠切除术后12周绒毛高度、隐窝深度和纵肌宽度显著增加，但对照组狗未增加（P<0.05）。回肠去神经支配导致近端50%肠切除术后持续体重减轻。尽管有腹泻，但电解质吸收仅发生轻微变化，回肠对简单营养物质的净吸收不受影响。去神经支配的狗的回肠在空肠切除术后经历更显著的形态学适应。小肠移植所需的去神经支配，独立于免疫效应，似乎不会抑制回肠的适应性反应以维持水、电解质和简单营养物质的净吸收。
