D'Haens G R, Geboes K, Peeters M, Baert F, Penninckx F, Rutgeerts P
Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Gastroenterology. 1998 Feb;114(2):262-7. doi: 10.1016/s0016-5085(98)70476-7.
BACKGROUND & AIMS: Postoperative recurrence of Crohn's disease may be triggered by agents in the fecal stream. The aim of this study was to examine intestinal mucosal inflammation induced by contact with intestinal fluids in surgically excluded ileum.
The effects of infusion of intestinal luminal contents into excluded ileum in 3 patients with Crohn's disease who had undergone a curative ileocolonic resection with ileocolonic anastomosis and temporary protective proximal loop ileostomy were studied by histopathology and electron microscopy.
Contact with intestinal fluids for 8 days induced focal infiltration of mononuclear cells, eosinophils, and polymorphonuclear cells in the lamina propria, small vessels, and epithelium in the excluded neoterminal ileum that was previously normal. Epithelial HLA-DR expression increased, and mononuclear cells expressed the KP-1 antigen associated with activation. Marked up-regulation of RFD-7, RFD-9, intercellular adhesion molecule 1, and lymphocyte function-associated antigen 1 was observed after infusion, reflecting epithelioid transformation and transendothelial lymphocyte recruitment. At the ultrastructural level, dilatation of the endoplasmic reticulum and Golgi apparatus occurred in epithelial cells, where also basally located transport vesicles were identified.
Intestinal contents trigger postoperative recurrence of Crohn's disease in the terminal ileum proximal to the ileocolonic anastomosis in the first days after surgery.
克罗恩病术后复发可能由粪流中的因素触发。本研究旨在检测手术旷置回肠与肠液接触所诱发的肠黏膜炎症。
通过组织病理学和电子显微镜检查，研究了3例克罗恩病患者在接受根治性回结肠切除、回结肠吻合及临时性近端回肠造口术后，向旷置回肠内输注肠腔内容物的影响。
与肠液接触8天可导致先前正常的旷置回肠末端固有层、小血管和上皮中出现单核细胞、嗜酸性粒细胞和多形核细胞的局灶性浸润。上皮HLA-DR表达增加，单核细胞表达与活化相关的KP-1抗原。输注后观察到RFD-7、RFD-9、细胞间黏附分子1和淋巴细胞功能相关抗原1显著上调，反映上皮样转化和经内皮淋巴细胞募集。在超微结构水平，上皮细胞内质网和高尔基体扩张，且可识别出位于基底的转运小泡。
术后最初几天，肠内容物可触发回结肠吻合口近端回肠末端克罗恩病的术后复发。
