Uchiyama M, Iwafuchi M, Ohsawa Y, Yagi M, Iinuma Y, Ohtani S
Department of Pediatric Surgery, Niigata University Hospital, Japan.
J Pediatr Surg. 1992 Jun;27(6):686-90. doi: 10.1016/s0022-3468(05)80091-0.
To evaluate the functioning and effectiveness of a reversed jejunal segment after extensive small bowel resection, we continuously measured the postoperative bowel motility (using bipolar electrodes and/or contractile strain gage force transducers) in interdigestive and postprandial conscious dogs at 2 to 5 weeks after surgery. The fasting duodenal migrating myoelectric (or motor) complex (MMC) occurred at markedly longer intervals in dogs with a 20-cm reversed jejunal segment created after 75% to 80% extensive small bowel resection (group 3) than in dogs that received extensive resection alone (group 2) or dogs that underwent construction of a reversed jejunal segment without bowel resection (group 1). The MMC arising from the duodenum was often interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly to the reversed segment or terminal ileum in group 3. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum above the proximal anastomosis in group 3. The duration of the postprandial period without duodenal MMC activity was significantly prolonged in groups 2 and 3. These results suggest that the transit time and passage of intestinal contents were delayed and that the periodical MMC was disturbed in group 3. The delay of transit time was due to prolongation of the interval between duodenal MMCs, the interruption of MMC propagation at the jejunum above the proximal anastomosis, the dominance of MMCs that followed the inherent anatomical continuity of the bowel, and discordant movements across the proximal anastomosis. Functional obstruction could be a potential problem in a 20-cm reversed jejunal segment inserted after extensive small bowel resection.
为评估广泛小肠切除术后逆行空肠段的功能及有效性,我们在术后2至5周,持续测量了清醒状态下的犬在消化间期和餐后的肠动力(使用双极电极和/或收缩应变计力传感器)。在接受75%至80%广泛小肠切除术后创建20厘米逆行空肠段的犬(第3组)中,空腹十二指肠移行性肌电(或运动)复合波(MMC)出现的间隔时间明显长于仅接受广泛切除的犬(第2组)或未进行肠切除而构建逆行空肠段的犬(第1组)。在第3组中,源自十二指肠的MMC常在近端吻合口上方的空肠处中断,且不能顺利迁移至逆行段或回肠末端。此外,第3组中逆行段和近端吻合口上方的空肠频繁出现短暂的不协调收缩。第2组和第3组餐后无十二指肠MMC活动的持续时间显著延长。这些结果表明,第3组中肠内容物的转运时间和通过延迟,且周期性MMC受到干扰。转运时间的延迟是由于十二指肠MMC之间的间隔延长、MMC在近端吻合口上方空肠处的传播中断、遵循肠道固有解剖连续性的MMC占主导以及近端吻合口处的不协调运动。在广泛小肠切除术后插入20厘米逆行空肠段时,功能性梗阻可能是一个潜在问题。