Appleton G V, Davies P W, Williamson R C
Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Br J Surg. 1990 Jul;77(7):768-72. doi: 10.1002/bjs.1800770717.
An intestinal suture line potentiates experimental carcinogenesis in its vicinity, probably due to adaptive hyperplasia. By contrast, a defunctioning colostomy causes distal hypoplasia, and fewer tumours develop. Male Sprague-Dawley rats (n = 160) were used to study adaptation (assessed by a stathmokinetic technique) and carcinogenesis (induced by azoxymethane) at an end-to-end anastomosis that was raised in either functioning or defunctioned left colon. Controls had no procedure and other rats had proximal colostomy alone. Defunction had a profound antitropic effect on the colon, reducing bowel length and weight and crypt cell production rate (CCPR) by 22-56 per cent. Anastomotic CCPR was increased by a factor of 2.6 over controls: mean(s.e.m.) values of 12.71(2.85) versus 4.87(0.41) cells/crypt/h (P less than 0.01), but defunction reduced this by 76 per cent to a mean(s.e.m.) value of 3.00(0.52) cells/crypt/h below that in the intact colon. In the left colon, 39-50 per cent of tumours were sited at the anastomosis. Compared with controls there were 77 per cent fewer tumours in defunctioned colon, but they still favoured the site of anastomosis. Neoplasms at the colostomy site accounted for 74-77 per cent of all right-sided tumours. Anastomosis and defunction have powerful but contrasting effects on colonic adaptation and carcinogenesis; when combined they tend to cancel each other out.
肠道缝合线会增强其附近的实验性致癌作用，这可能是由于适应性增生所致。相比之下，无功能的结肠造口术会导致远端发育不全，肿瘤发生较少。雄性斯普拉格 - 道利大鼠（n = 160）被用于研究在左半结肠进行端对端吻合术时的适应性（通过有丝分裂抑制技术评估）和致癌作用（由氧化偶氮甲烷诱导），该吻合术在功能正常或无功能的左半结肠中进行。对照组未进行任何手术，其他大鼠仅进行近端结肠造口术。无功能对结肠有显著的反向作用，使肠长度、重量和隐窝细胞产生率（CCPR）降低22% - 56%。吻合口处的CCPR比对照组增加了2.6倍：平均（标准误）值为12.71（2.85）个细胞/隐窝/小时，而对照组为4.87（0.41）个细胞/隐窝/小时（P < 0.01），但无功能使该值降低了76%，至平均（标准误）值为3.00（0.52）个细胞/隐窝/小时，低于完整结肠。在左半结肠，39% - 50%的肿瘤位于吻合口处。与对照组相比，无功能结肠中的肿瘤减少了77%，但它们仍倾向于在吻合口部位发生。结肠造口部位的肿瘤占所有右侧肿瘤的74% - 77%。吻合术和无功能对结肠适应性和致癌作用具有强大但相反的影响；两者结合时往往相互抵消。
