高分辨率结肠测压法定义的结肠手术后远端结肠过度活跃的循环运动。
Hyperactive cyclic motor activity in the distal colon after colonic surgery as defined by high-resolution colonic manometry.
机构信息
Department of Surgery, University of Auckland, Auckland, New Zealand.
Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
出版信息
Br J Surg. 2018 Jun;105(7):907-917. doi: 10.1002/bjs.10808. Epub 2018 Apr 14.
BACKGROUND
Recovery after colonic surgery is invariably delayed by disturbed gut motility. It is commonly assumed that colonic motility becomes quiescent after surgery, but this hypothesis has not been evaluated rigorously. This study quantified colonic motility through the early postoperative period using high-resolution colonic manometry.
METHODS
Fibre-optic colonic manometry was performed continuously before, during and after surgery in the left colon and rectum of patients undergoing right hemicolectomy, and in healthy controls. Motor events were characterized by pattern, frequency, direction, velocity, amplitude and distance propagated.
RESULTS
Eight patients undergoing hemicolectomy and nine healthy controls were included in the study. Colonic motility became markedly hyperactive in all operated patients, consistently dominated by cyclic motor patterns. Onset of cyclic motor patterns began to a minor extent before operation, occurring with increasing intensity nearer the time of surgery; the mean(s.d.) active duration was 12(7) per cent over 3 h before operation and 43(17) per cent within 1 h before surgery (P = 0.024); in fasted controls it was 2(4) per cent (P < 0·001). After surgery, cyclic motor patterns increased markedly in extent and intensity, becoming nearly continuous (active duration 94(13) per cent; P < 0·001), with peak frequency 2-4 cycles per min in the sigmoid colon. This postoperative cyclic pattern was substantially more prominent than in non-operative controls, including in the fed state (active duration 27(20) per cent; P < 0·001), and also showed higher antegrade velocity (P < 0·001).
CONCLUSION
Distal gut motility becomes markedly hyperactive with colonic surgery, dominated by cyclic motor patterns. This hyperactivity likely represents a novel pathophysiological aspect of the surgical stress response. Hyperactive motility may contribute to gut dysfunction after surgery, potentially offering a new therapeutic target to enhance recovery.
背景
结肠手术后的恢复总是会因肠道蠕动紊乱而延迟。人们普遍认为，结肠手术后蠕动会变得静止，但这一假设尚未得到严格评估。本研究通过高分辨率结肠测压术在术后早期量化了结肠蠕动。
方法
对接受右半结肠切除术的患者的左结肠和直肠以及健康对照者进行术前、术中和术后连续纤维光学结肠测压。通过模式、频率、方向、速度、幅度和传播距离来描述运动事件。
结果
本研究纳入了 8 例接受半结肠切除术的患者和 9 例健康对照者。所有手术患者的结肠蠕动均明显活跃，始终以周期性运动模式为主。周期性运动模式的起始时间略早于手术，在手术时间临近时强度增加；手术前 3 小时的平均（标准差）活跃时间为 12（7）%，手术前 1 小时内为 43（17）%（P=0.024）；空腹对照组为 2（4）%（P<0·001）。手术后，周期性运动模式的范围和强度显著增加，几乎连续（活跃时间 94（13）%；P<0·001），乙状结肠的峰值频率为 2-4 个周期/分钟。这种术后周期性模式明显比非手术对照组更为突出，包括进食状态（活跃时间 27（20）%；P<0·001），也表现出更高的前向速度（P<0·001）。
结论
结肠手术后，远侧肠道蠕动明显活跃，以周期性运动模式为主。这种活跃性可能代表手术应激反应的一个新的病理生理方面。活跃的蠕动可能会导致手术后肠道功能障碍，可能为增强恢复提供一个新的治疗靶点。
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