Quigley E M, Spanta A D, Rose S G, Lof J, Thompson J S
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-2000.
Dig Dis Sci. 1990 Dec;35(12):1505-17. doi: 10.1007/BF01540569.
We studied the longitudinal effects of autotransplantation on the motor function of the jejunoileum. By performing the autotransplantation procedure in a manner similar to that employed for allotransplantation, we sought to examine the long-term effects of both extrinsic denervation and the operative procedure itself on small intestinal motor function. Although initially disrupted, interdigestive myoelectrical activity demonstrated progressive organization: 88% of migrating myoelectrical complexes in animals studied between 12 and 20 months following autotransplantation demonstrated each phase of the complex in normal sequence. Longitudinal studies of several parameters of myoelectrical activity provided further evidence of progressive organization and entrainment of motor functions within the denervated intestine. Several abnormal myoelectrical patterns were observed within the autotransplanted segment, however, and coordination of either slow wave or phase III activity with the proximal innervated intestine did not recover with time. The major component of the myoelectrical response to feeding was permanently impaired with a delayed onset and shortened duration of the fed response. We conclude that the extrinsically denervated intestine recovers the ability to generate and organize all phases of the MMC but demonstrates permanent impairment of the major motor response to food. However, anoxic and cooling damage to enteric nerves and muscle, incurred during the autotransplantation procedure, may explain the persistence of abnormal motor patterns and impaired myoelectrical conduction and could play an important role, additional to that of extrinsic denervation, in the long-term motor function of the allotransplanted intestine.
我们研究了自体移植对空回肠运动功能的纵向影响。通过以与同种异体移植相似的方式进行自体移植手术,我们试图研究外在去神经支配和手术操作本身对小肠运动功能的长期影响。尽管消化间期肌电活动最初受到干扰,但显示出逐渐的组织化:在自体移植后12至20个月进行研究的动物中,88%的移行性肌电复合波按正常顺序显示出复合波的各个阶段。对肌电活动几个参数的纵向研究进一步证明了去神经肠道内运动功能的逐渐组织化和同步化。然而,在自体移植段内观察到了几种异常的肌电模式,并且慢波或Ⅲ期活动与近端有神经支配的肠道之间的协调性并未随时间恢复。进食时肌电反应的主要成分永久受损,进食反应的起始延迟且持续时间缩短。我们得出结论,外在去神经支配的肠道恢复了产生和组织移行性运动复合波各阶段的能力,但对食物的主要运动反应表现出永久性损伤。然而,自体移植手术过程中发生的对肠神经和肌肉的缺氧及冷却损伤,可能解释了异常运动模式的持续存在以及肌电传导受损的原因,并且在同种异体移植肠道的长期运动功能中,除了外在去神经支配之外,可能起到重要作用。