Huang Li, Liang Li-jian, Lai Jia-ming
Department of Hepatobiliary Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Wai Ke Za Zhi. 2008 Jun 1;46(11):839-42.
To evaluate influences on intestinal structure and myoelectric motility between modified uncut jejunal loop and Roux-en-Y procedures for biliodigestive anastomosis.
Fifteen rabbits were randomized in modified uncut jejunal loop group, Roux-en-Y group and control group. Traced fasting slow-wave frequency (SWF) before biliodigestive diversion and 25 d postoperative (POD25) during laparotomy. Before the second laparotomy on POD21, the fasting SWF, percentage of abroad migrating myoelectric complex (MMC%), the postprandial spike potential frequency (SPF) and percentage of abroad propagation (SP%) were recorded in vivo. Compared myoelectric recordings according to parameters above. On POD90, harvested the stitched ligation of ascending loop and part of descending loop in uncut group, and biliary limb in R-Y animals, which assessed under HE, c-kit labeling immunohistochemical staining and transmission electron microscope(TEM).
On POD25, SWF declined mildly in uncut group (8.4%) and markedly in R-Y group (23.8%) respectively. The difference was significant (P<0.05). Before laparotomy on POD21 when abdomen closed, between uncut and control animals, there were statistical difference in fasting SWF and postprandial SPF (P<0.05), while no significance in MMC% and SP% (P>0.05). Moreover, differences of each parameters between R-Y group and control or uncut group were markedly statistical (P<0.01). Abroad myoelectric propagation through the ligated segment can be observed in uncut animals. Meanwhile, ectopic pacemaker was detected locating in the proximal segment of the Roux limb and triggering retrograde propagation in R-Y animals. On POD90, no recanalization were observed In uncut animals. Furthermore, occluded lumen with mild atrophic mucosa under microscope and c-kit labeling cells located in the inner circular muscle layer were observed, which proven to be Interstitial cells of Cajal (ICCs) by TEM. In R-Y animals, lumen of the Roux limb dilated. There's no significant difference in c-kit labeling area between R-Y and uncut animals by image analysis system. Reductions of processes and intercellular gap junction in ICCs, and loose interconnections between ICCs and SMCS or nerve endings were observed in R-Y animals.
Impaired gastrointestinal motility after the Roux-en-Y procedure may due to the aberrant interstitial cells of Cajal. Modified uncut technique reveals a reliable and effective alternative for biliodigestive reconstruction.
评估改良未切断空肠袢与Roux-en-Y术式行胆肠吻合对肠道结构及肌电活动的影响。
将15只家兔随机分为改良未切断空肠袢组、Roux-en-Y组和对照组。记录胆肠转流术前及术后25天（术后第25天）剖腹探查时的空腹慢波频率（SWF）。在术后第21天第二次剖腹探查前，记录体内空腹SWF、移行性复合肌电（MMC）百分比、餐后峰电位频率（SPF）及广泛传播百分比（SP%）。根据上述参数比较肌电记录。术后第90天，在未切断组采集升袢及部分降袢的缝合结扎处，在R-Y组采集胆支，进行苏木精-伊红（HE）染色、c-kit标记免疫组化染色及透射电镜（TEM）评估。
术后第25天，未切断组SWF轻度下降（8.4%），R-Y组显著下降（23.8%），差异有统计学意义（P<0.05）。术后第21天剖腹探查关腹时，未切断组与对照组空腹SWF及餐后SPF有统计学差异（P<0.05），MMC%及SP%无差异（P>0.05）。此外，R-Y组与对照组或未切断组各参数差异均有显著统计学意义（P<0.01）。在未切断组动物中可观察到肌电通过结扎段广泛传播。同时，在R-Y组动物中检测到异位起搏点位于Roux袢近端并引发逆行传播。术后第90天，未切断组动物未见再通。此外，显微镜下观察到未切断组肠腔闭塞，黏膜轻度萎缩，c-kit标记细胞位于内环肌层，经TEM证实为Cajal间质细胞（ICC）。在R-Y组动物中，Roux袢肠腔扩张。图像分析系统显示R-Y组与未切断组c-kit标记面积无显著差异。在R-Y组动物中观察到ICC的突起及细胞间缝隙连接减少，ICC与平滑肌细胞或神经末梢之间的连接疏松。
Roux-en-Y术后胃肠动力受损可能与Cajal间质细胞异常有关。改良未切断技术为胆肠重建提供了一种可靠有效的替代方法。
