Little D, Tomlinson J E, Blikslager A T
Colic and Digestive Disease Program, Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, 4700 Hillsborough Street, Raleigh, North Carolina 27606, USA.
Equine Vet J. 2005 Jul;37(4):329-35. doi: 10.2746/0425164054529472.
Post operative ileus (POI) remains an important cause of post operative morbidity and mortality in the horse. However, clinical progression of naturally occurring cases of POI in both horse and man does not entirely support the 'neurogenic' hypothesis as the sole mechanism of POI; and the hypothesis that inflammation plays a major role at 12-24 h after surgery requires validation.
An inflammatory infiltrate in the muscularis externa and myenteric plexus of equine jejunum is present 18 h following a period of ischaemia.
Samples of normal jejunum, jejunum from the proximal resection margins of clinical cases and jejunum obtained 18 h after 1 or 2 h ischaemia or manipulation alone were evaluated for neutrophil infiltration. Samples obtained 18 h after surgery were additionally evaluated for leucocyte activation using calprotectin immunohistochemistry. Results were evaluated by ANOVA and P < 0.05 was considered significant.
Significant neutrophilic inflammation was identified in the samples from the proximal resection margins of clinical cases compared to uninjured jejunum. In experimental cases, neutrophilic inflammation appeared to be increased further by 18 h and was identified through all intestinal layers, particularly in the serosa, fascial planes around circular and longitudinal muscle fibres, and myenteric plexus. This elevated level of neutrophilic inflammation was mirrored by an increased number of calprotectin-positive cells in these intestinal layers, indicating leucocyte activation.
Significant neutrophilic inflammation occurs in equine jejunal myenteric layers 18 h after surgery.
This neutrophilic inflammation coincides with the clinical time point at which POI is identified and may indicate that inflammatory pathways, rather than solely neurogenic pathways, are responsible for POI in the horse.
术后肠梗阻（POI）仍是马术后发病和死亡的重要原因。然而，马和人自然发生的POI临床进展并不完全支持“神经源性”假说作为POI的唯一机制；并且炎症在术后12 - 24小时起主要作用这一假说需要验证。
在一段缺血期后18小时，马空肠的肌层和肌间神经丛存在炎性浸润。
对正常空肠样本、临床病例近端切除边缘的空肠样本以及在1或2小时缺血或仅进行操作后18小时获取的空肠样本进行中性粒细胞浸润评估。对术后18小时获取的样本，还使用钙卫蛋白免疫组织化学评估白细胞活化情况。结果通过方差分析进行评估，P < 0.05被认为具有统计学意义。
与未损伤的空肠相比，在临床病例近端切除边缘的样本中发现了显著的中性粒细胞炎症。在实验病例中，中性粒细胞炎症在18小时时似乎进一步增加，并在整个肠壁各层均有发现，特别是在浆膜、环行和纵行肌纤维周围的筋膜平面以及肌间神经丛。这些肠壁各层中钙卫蛋白阳性细胞数量增加反映了中性粒细胞炎症水平的升高，表明白细胞活化。
术后18小时马空肠肌间层出现显著的中性粒细胞炎症。
这种中性粒细胞炎症与识别出POI的临床时间点相符，可能表明炎症途径而非仅神经源性途径是马POI的病因。
