Irvin T T, Bostock T
Surg Gynecol Obstet. 1976 Sep;143(3):443-7.
The results of clinical studies have suggested that inadequate preoperative mechanical preparation of the colon is a significant factor in the pathogenesis of disruption of colonic and colorectal anastomoses. A possible explanation for the adverse effect of poor mechanical preparation is that ammonia released from feces has a cytotoxic effect on the healing anastomosis. It has been suggested that acidification of the colonic lumen prevents the release of fecal ammonia and protects the anastomoses. The effects of mechanical preparation of the colon and colonic acidification were studied in anastomoses in the left colon of rats. Colonic acidification was produced by the oral administration of a synthetic disaccharide lactulose solution. Mechanical preparation resulted in a significant increase in the bursting wall tension in anastomoses on the seventh postoperative day. The oral administration of lactulose resulted in a reduction in the colonic mucosal pH, but this was not accompanied by improved healing of anastomoses, as judged by measurements of colonic bursting pressure, bursting wall tension and total challagen content. Mechanical preparation of the colon is an important factor in the safety of colonic anastomosis. However, the results do not suggest that acidification of the colonic lumen significantly improves the quality of colonic healing.
临床研究结果表明，术前结肠机械准备不足是导致结肠和结直肠吻合口破裂发病机制中的一个重要因素。机械准备不佳产生不良影响的一个可能解释是，粪便释放的氨对愈合中的吻合口具有细胞毒性作用。有人提出，结肠腔酸化可防止粪便氨的释放并保护吻合口。在大鼠左半结肠吻合术中研究了结肠机械准备和结肠酸化的效果。通过口服合成二糖乳果糖溶液实现结肠酸化。机械准备导致术后第七天吻合口的破裂壁张力显著增加。口服乳果糖导致结肠黏膜pH值降低，但根据结肠破裂压力、破裂壁张力和总胶原蛋白含量的测量判断，这并未伴随吻合口愈合改善。结肠的机械准备是结肠吻合安全的一个重要因素。然而，结果并未表明结肠腔酸化能显著改善结肠愈合质量。
