de Silva H J, Millard P R, Soper N, Kettlewell M, Mortensen N, Jewell D P
Department of Gastroenterology, John Radcliffe Hospital, Oxford.
Gut. 1991 Oct;32(10):1166-9. doi: 10.1136/gut.32.10.1166.
This study aimed to investigate the effects of the faecal stream and stasis on the mucosa of ileal pouches. Nine patients were followed up. Two pouch biopsy specimens were obtained from each at the time of pouch formation, ileostomy closure, and three, six, and 12 months after operation. None developed pouchitis. Two pouch biopsy specimens each were also obtained from 20 patients (six with pouchitis), whose pouches had been functioning for at least a year and in whom pouch evacuation was assessed by radioisotope labelled artificial stool. Biopsy specimens were assessed for the degree of acute and chronic inflammation, mucin type (high iron diamine-alcian blue stain), a morphometric index of villous atrophy (villous height:total mucosal thickness), and crypt cell proliferation (using the monoclonal antibody Ki67). Mean values from the two biopsy specimens were obtained for each parameter. After three months of pouch function, the scores for acute and chronic inflammation, the degree of sulphomucin, and crypt cell proliferation were significantly higher, and the index of villous atrophy was significantly lower (indicating a greater degree of villous atrophy), than at pouch formation or at ileostomy closure. The values at pouch formation and ileostomy closure were similar. For all parameters, the changes seen at six and 12 months were not significantly different from those at three months. There was no significant correlation between the efficiency of pouch evacuation and any of the mucosal changes. It is concluded that exposure to the faecal stream is necessary for changes to take place in the pouch mucosa, although the amount of stasis, as measured by radioisotopic evacuation studies, seems to be irrelevant. The mucosal changes occur soon after ileostomy closure and then remain stable for at least one year.
本研究旨在调查粪流和淤滞对回肠贮袋黏膜的影响。对9例患者进行了随访。在贮袋形成时、回肠造口关闭时以及术后3个月、6个月和12个月，分别从每位患者获取两份贮袋活检标本。无一例发生贮袋炎。还从20例患者（6例有贮袋炎）获取了两份贮袋活检标本，这些患者的贮袋已正常运作至少一年，且通过放射性同位素标记的人工粪便评估贮袋排空情况。对活检标本进行急性和慢性炎症程度、黏蛋白类型（高铁二胺 - 阿尔辛蓝染色）、绒毛萎缩形态计量指数（绒毛高度：总黏膜厚度）以及隐窝细胞增殖（使用单克隆抗体Ki67）的评估。对每个参数获取两份活检标本的平均值。贮袋功能3个月后，急性和慢性炎症评分、硫酸黏蛋白程度以及隐窝细胞增殖均显著高于贮袋形成时或回肠造口关闭时，而绒毛萎缩指数显著低于（表明绒毛萎缩程度更高）贮袋形成时或回肠造口关闭时。贮袋形成时和回肠造口关闭时的值相似。对于所有参数，6个月和12个月时观察到的变化与3个月时无显著差异。贮袋排空效率与任何黏膜变化之间均无显著相关性。结论是，尽管通过放射性同位素排空研究测量的淤滞量似乎无关，但粪流暴露是贮袋黏膜发生变化所必需的。黏膜变化在回肠造口关闭后很快出现，然后至少一年内保持稳定。
