Uchiyama M, Iwafuchi M, Matsuda Y, Yagi M, Kondoh K, Ohtani S, Homma S
Department of Pediatric Surgery, Niigata University School of Medicine.
J Smooth Muscle Res. 1996 Feb;32(1):17-26. doi: 10.1540/jsmr.32.17.
To evaluate the functioning and effectiveness of a 20-cm reversed jejunal segment after 75-80% massive small bowel resection (MSBR), and whether migrating polarity changes or not, we continuously measured the postoperative bowel motility (using bipolar electrodes and/or contractile strain gage force transducers) in interdigestive and postprandial conscious dogs in short- (2-5 weeks) and long-term (6-10 months) after surgery. The fasting migrating myoelectric (or motor) complex (MMC) arising from the duodenum was often interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly to the reversed segment or terminal ileum. In addition, brief small discordant contractions were frequent in the jejunum above the proximal anastomosis and the proximal part of the reversed segment. The duodenal MMCs predominantly propagated to the ileum through the inherent anatomic continuity of the bowel. These findings of the MMC propagation pattern are very similar in short- and in long-term after surgery. The duration of the postprandial period without duodenal MMC activity was markedly longer in short-term, but shorter in long-term (both were significantly longer than in controls). Marked dilatation of the jejunum and reversed jejunal segment was noted across the proximal anastomosis. These results suggest that the transit time and passage of intestinal contents can be delayed and stagnated for at least 10 months after MSBR with a 20-cm reversed jejunal segment. Although, reports on the polarity of peristalsis in the reversed segment in long-term followup have been contradictory in both experimental and clinical studies, this results support the conclusion that the reversed jejunal segment maintains its inherent propagative polarity and pattern over a long postoperative period.
为评估在75 - 80%大面积小肠切除（MSBR）后一段20厘米反转空肠段的功能及有效性，以及其极性是否发生改变，我们在术后短期（2 - 5周）和长期（6 - 10个月），持续测量清醒状态下犬在消化间期和餐后的肠动力（使用双极电极和/或收缩应变计力传感器）。源自十二指肠的空腹移行性肌电（或运动）复合波（MMC）常在近端吻合口上方的空肠处中断，无法顺利迁移至反转段或回肠末端。此外，在近端吻合口上方的空肠和反转段近端频繁出现短暂的不协调收缩。十二指肠MMC主要通过肠道固有的解剖连续性向回肠传播。MMC传播模式的这些发现在术后短期和长期非常相似。术后短期内无十二指肠MMC活动的餐后时长明显更长，但长期则较短（两者均显著长于对照组）。在近端吻合口处可见空肠和反转空肠段明显扩张。这些结果表明，在进行20厘米反转空肠段的MSBR术后，肠内容物的通过时间和传输至少可延迟和停滞10个月。尽管在长期随访中，关于反转段蠕动极性的报告在实验和临床研究中都存在矛盾，但本研究结果支持这样的结论，即反转空肠段在术后很长一段时间内保持其固有的传播极性和模式。
