Galvão F H Ferreira, Seid V E, Nunes dos Santos R M, Kitamura M, de Castro Galvão R, Ambar Pinto R, Miyashiro Nunes dos Santos R
Department of Gastroenterology, Division of Transplantation, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Tech Coloproctol. 2009 Mar;13(1):55-9. doi: 10.1007/s10151-009-0459-5. Epub 2009 Mar 14.
Anorectal transplantation is a valid procedure for the treatment of anorectal dysfunction; however, the lack of a suitable animal model has hampered the development of this method. We describe a simple technique for anorectal transplantation in the rat and compare this procedure with colostomy.
The anorectal segment including the skin surrounding the anus were freed by abdominal and perineal dissection. In a heterotopically transplanted group the segment was exteriorized by the formation of an anus through an abdominal incision. In an orthotopically transplanted group the segment was replaced in its original position and reimplanted by suturing. In another group a distal colostomy was performed. A sham-treated control group (simulated surgical procedure) was also included. Changes in behavior, characteristics of the stool, body weight and survival rate were assessed by daily clinical examination. Moribund animals, those with a weight loss of more than 30%, and those surviving at 1 month were killed by an overdose of anesthetic. The results were analyzed using the Mann Whitney, Student's t and chi-squared tests, and p<0.05 was considered significant.
Within 4 days after the operation, animals submitted to orthotopic or heterotopic transplantation had achieved normal defecation, body weight gain and clinical evolution similar to the sham-treated group. The overall mortality in these groups was 4.16%. In contrast, colostomized animals showed a high incidence of diarrhea, intestinal obstruction, stress posture and violent behavior (p</=0.05), and a mortality rate of 58.33%.
Autotransplantation in the rat is a simple technique, achieves a high rate of success and better clinical evolution than colostomy. This model may ultimately lead to research into anorectal transplantation.
肛门直肠移植是治疗肛门直肠功能障碍的一种有效方法；然而，缺乏合适的动物模型阻碍了该方法的发展。我们描述了一种在大鼠中进行肛门直肠移植的简单技术，并将该手术与结肠造口术进行比较。
通过腹部和会阴解剖游离包括肛门周围皮肤的肛门直肠段。在异位移植组中，通过腹部切口形成肛门使该段外置。在原位移植组中，将该段放回其原始位置并通过缝合重新植入。在另一组中进行远端结肠造口术。还包括一个假手术对照组（模拟手术操作）。通过每日临床检查评估行为变化、粪便特征、体重和存活率。濒死动物、体重减轻超过30%的动物以及存活1个月的动物通过过量麻醉处死。使用曼-惠特尼检验、学生t检验和卡方检验分析结果，p<0.05被认为具有统计学意义。
术后4天内，接受原位或异位移植的动物排便、体重增加和临床进展正常，与假手术组相似。这些组的总死亡率为4.16%。相比之下，结肠造口术动物腹泻、肠梗阻、应激姿势和暴力行为的发生率较高（p≤0.05），死亡率为58.33%。
大鼠自体移植是一种简单的技术，成功率高，临床进展优于结肠造口术。该模型最终可能会推动肛门直肠移植的研究。
