Schwarz Nicolas T, Kalff Jörg C, Türler Andreas, Speidel Nicola, Grandis Jennifer R, Billiar Timothy R, Bauer Anthony J
Chirurgische Universitätsklinik der Friedrich-Wilhelms-Universität, Bonn, Germany.
Gastroenterology. 2004 Jan;126(1):159-69. doi: 10.1053/j.gastro.2003.10.060.
Small bowel manipulation initiates an intense molecular and cellular inflammatory response within the jejunal muscularis, which causes ileus. The current objective was to investigate pan-enteric inflammatory molecular and functional motility alterations of the muscularis from the unmanipulated stomach and colon initiated by selective jejunal manipulation.
Rat jejunum was manipulated, and animals sacrificed between 0-24 hours. In vivo gastric emptying, gastrointestinal transit, and in vitro colonic circular muscle recordings were measured. Reverse-transcriptase polymerase chain reaction (RT-PCR) and electromobility shift assay (EMSA) of gastric, jejunal, and colonic muscularis extracts were performed. Whole mounts were histochemically stained for myeloperoxidase leukocytes.
Surgical manipulation suppressed jejunal contractions that were significantly prevented by dexamethasone pretreatment. Selective jejunal manipulation also suppressed in vivo gastric emptying, gastrointestinal transit, and in vitro colonic circular muscle contractility. Nuclear factor interleukin-6 (NF-IL-6) was activated within the gastric and colonic muscularis. RT-PCR showed a 14.9-, 8.1-, and 11.4-fold up-regulation of IL-6 messenger RNA within the jejunal, gastric, and colonic muscularis, respectively. EMSA showed a 30.6-, 14.2-, and 20.8-fold increased activation of signal transducer and activator of transcription (STAT) proteins in jejunal, gastric, and colonic muscularis extracts, respectively. Tumor necrosis factor-alpha, cyclooxygenase-2, and inducible nitric oxide synthase showed a significant up-regulation in the manipulated jejunum, as well as the unmanipulated gastric and colonic muscularis. Neutrophils were significantly recruited into all gastrointestinal regions.
Selective small bowel manipulation leads to a molecular, cellular, and functional pan-enteric "field effect" phenomenon in the unmanipulated gastric and colonic muscularis.
小肠操作可引发空肠肌层内强烈的分子和细胞炎症反应，进而导致肠梗阻。当前的目标是研究由选择性空肠操作引发的、未受操作的胃和结肠肌层的全肠道炎症分子及功能性运动改变。
对大鼠空肠进行操作，并在0至24小时内处死动物。测量体内胃排空、胃肠转运以及体外结肠环行肌记录。对胃、空肠和结肠肌层提取物进行逆转录聚合酶链反应（RT-PCR）和电泳迁移率变动分析（EMSA）。对全层标本进行髓过氧化物酶白细胞的组织化学染色。
手术操作抑制了空肠收缩，地塞米松预处理可显著预防这种抑制。选择性空肠操作还抑制了体内胃排空、胃肠转运以及体外结肠环行肌收缩力。胃和结肠肌层内的核因子白细胞介素-6（NF-IL-6）被激活。RT-PCR显示空肠、胃和结肠肌层内白细胞介素-6信使核糖核酸分别上调了14.9倍、8.1倍和11.4倍。EMSA显示空肠、胃和结肠肌层提取物中转录信号转导子和激活子（STAT）蛋白的激活分别增加了30.6倍、14.2倍和20.8倍。肿瘤坏死因子-α、环氧化酶-2和诱导型一氧化氮合酶在操作的空肠以及未受操作的胃和结肠肌层中均显著上调。中性粒细胞被显著募集到所有胃肠道区域。
选择性小肠操作会在未受操作的胃和结肠肌层中导致分子、细胞和功能性的全肠道“场效应”现象。
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