Dudrick S J, Daly J M, Castro G, Akhtar M
Ann Surg. 1977 Jun;185(6):642-8. doi: 10.1097/00000658-197706000-00005.
Small intestinal morphologic and biochemical changes were studied following jejuno-ileal bypass for obesity after body weight stabilization had occurred. Four patients underwent biopsy of in-continuity and bypassed jejunal and ileal segments of the small intestine 11 to 22 months after the bypass operation. Microscopically, marked mucosal villus hypertrophy of the in-continuity bowel was observed, especially in the ileum. Bypassed jejunal mucosa underwent atrophy compared with pre-bypass jejunum, whereas bypassed ileum appeared similar microscopically to pre-bypass ileum. The specific activities of mucosal disaccharidase enzymes (maltase, sucrase, lactase and trehalase) in units per mg protein remained similar to pre-bypass levels in segments of the in-continuity jejunum and the bypassed jejunum and ileum. On the other hand, elevated mucosal disaccharidase levels were measured in biopsy specimens of the in-continuity ileum. Total enzyme activity per unit length of intestine, however, was estimated to be elevated in both in-continuity jejunum and ileum secondary to mucosal villus hypertrophy. These data indicate that following small bowel bypass: (1) the in-continuity ileum undergoes greater biochemical and morphologic adaptation than the jejunum; and (2) intraluminal nutrients and chyme appear to be essential to maximal intestinal adaptation.
在体重稳定后，对空肠回肠旁路术治疗肥胖后的小肠形态学和生化变化进行了研究。4例患者在旁路手术后11至22个月接受了连续小肠段以及旁路空肠和回肠段的活检。显微镜下，观察到连续肠段出现明显的黏膜绒毛肥大，尤其是在回肠。与旁路术前的空肠相比，旁路空肠黏膜发生萎缩，而旁路回肠在显微镜下与旁路术前的回肠相似。黏膜双糖酶（麦芽糖酶、蔗糖酶、乳糖酶和海藻糖酶）的比活性（以每毫克蛋白质的单位数计）在连续空肠段以及旁路空肠和回肠段中与旁路术前水平相似。另一方面，在连续回肠的活检标本中检测到黏膜双糖酶水平升高。然而，由于黏膜绒毛肥大，连续空肠和回肠每单位肠长度的总酶活性估计升高。这些数据表明，小肠旁路术后：（1）连续回肠比空肠经历更大的生化和形态学适应；（2）肠腔内营养物质和食糜似乎对最大程度的肠道适应至关重要。
