Büyükyavuz I, Talim B, Ciftci A O, Kale G, Senocak M E, Büyükpamukçu N
Department of Pediatric Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
J Pediatr Surg. 2004 Apr;39(4):582-6. doi: 10.1016/j.jpedsurg.2003.12.019.
BACKGROUND/PURPOSE: Whole-bowel irrigation (WBI) has been used for different purposes. It has been the preferred method of bowel cleansing before large bowel surgery and colonoscopy. There are some studies about histopathologic alterations in the gastrointestinal system caused by WBI. It was reported that large quantities of bile-stained intraluminal fluid were seen after WBI with lactated Ringer's solution. In light of all these studies, the authors have decided to inspect whether WBI is choleretic and whether the histopathologic findings in the gastrointestinal system are caused by this choleretic effect.
During the experimental procedures, animals at first were divided into 2 major groups of A and B; A consisted of the animals whose bile was not collected, and B consisted of animals whose bile was collected. Later, these 2 groups were divided into 4 subgroups consisting of 6 animals each. Sham operations were performed on the animals in group SH-A and SH-B. The animals in group saline-A and saline-B were given 0.9% of sodium chloride (isotonic sodium chloride). The animals in group LR-A and LR-B received lactated Ringer's solution. The last group (PEG-A and PEG-B) underwent WBI by using polyethylene glycol solution (PEG). After completing WBI, animals were rested for 4 hours, and at the end of resting time, laparotomy was performed to take biopsy specimens from stomach, small bowel, and large bowel. All of the specimens were evaluated and graded for congestion, edema, and inflammation by the individual blinded pathologist.
According to the results, WBI has been shown to affect biliary secretion and to have a choleretic effect (P <.05, Tuckey-Kramer). The choleretic effect has also been shown to be responsible for histopathologic alterations in some groups (P <.05, Tuckey-Kramer). The most severe changes of congestion, edema, and inflammation have been detected in isotonic sodium chloride solutions in all groups. The least alterations have been seen in lactated Ringer's and PEG solutions.
In light of these findings, it might be concluded that the use of WBI can cause different degrees of histopathologic changes in gastrointestinal system depending on the type of solutions. WBI has been shown to have choleretic effect, and it was found that there is a connection between histopathologic changes in gastrointestinal system and choleretic effect of WBI.
背景/目的：全肠道灌洗（WBI）已被用于不同目的。它一直是大肠手术和结肠镜检查前肠道清洁的首选方法。有一些关于WBI引起的胃肠道系统组织病理学改变的研究。据报道，用乳酸林格氏液进行WBI后，可见大量胆汁染色的肠腔内液体。鉴于所有这些研究，作者决定检查WBI是否具有利胆作用，以及胃肠道系统的组织病理学发现是否由这种利胆作用引起。
在实验过程中，动物首先被分为A组和B组两个主要组；A组由未收集胆汁的动物组成，B组由收集胆汁的动物组成。之后，这两组又被分为4个亚组，每组6只动物。对SH-A组和SH-B组的动物进行假手术。给盐水-A组和盐水-B组的动物注射0.9%的氯化钠（等渗氯化钠）。给LR-A组和LR-B组的动物注射乳酸林格氏液。最后一组（PEG-A组和PEG-B组）使用聚乙二醇溶液（PEG）进行WBI。完成WBI后，让动物休息4小时，在休息结束时，进行剖腹手术以获取胃、小肠和大肠的活检标本。所有标本由独立的盲法病理学家进行充血、水肿和炎症的评估和分级。
根据结果，WBI已被证明会影响胆汁分泌并具有利胆作用（P <.05，Tuckey-Kramer检验）。利胆作用也被证明是某些组中组织病理学改变的原因（P <.05，Tuckey-Kramer检验）。在所有组中，等渗氯化钠溶液中检测到的充血、水肿和炎症变化最为严重。在乳酸林格氏液和PEG溶液中观察到的变化最小。
根据这些发现，可以得出结论，WBI的使用可能会根据溶液类型在胃肠道系统中引起不同程度的组织病理学变化。WBI已被证明具有利胆作用，并且发现胃肠道系统的组织病理学变化与WBI的利胆作用之间存在联系。
