回直肠吻合分流术对慢传输型便秘大鼠血浆SP及VIP的影响

目的:完成STC大鼠回肠直肠吻合分流手术,观察该术式对STC大鼠血浆SP、VIP的影响.方法:72只SD大鼠,随机取10只作为正常对照组,其余62只用大黄小剂量递增灌胃造模.造模过程中死亡5只,剩余57只,手术前处死12只作为模型对照组.剩余的45只大鼠,随机35只手术组,10只自然恢复组,测定并比较各组大鼠血浆中SP及VIP的含量.结果:SP水平:与正常对照组相比,模型组大鼠血浆SP水平显著降低(63.364±4.211vs81.032±4.237,P<0.01);恢复组对比模型组SP水平降低显著(50.138±5.283vs63.364±4.211,P<0.01);术后1mo,手术组对比恢复组数值增高(58.165±6.592vs50.138±5.283,P<0.05);但仍然低于模型组(58.165±6.592vs63.364±4.211,P<0.05).VIP水平:与正常对照组相比,模型组大鼠血浆VIP水平显著升高(32.152±6.204vs25.469±4.523,P<0.01);恢复组较模型组下降(25.217±3.517vs32.152±6.204,P<0.05),且与正常对照组无显著差异.手术组对比恢复组无显著差异.结论:回直肠吻合分流术明显改善STC大鼠的便秘症状,减轻结肠负担后能减轻结肠功能的进一步恶化,但能否促进大鼠结肠功能恢复尚待进一步研究.     

通便胶囊对慢传输型便秘模型大鼠胃肠激素影响的研究

[目的]观察通便胶囊对慢传输型便秘(STC)模型大鼠胃肠激素的影响。[方法]SD大鼠60只,随机分为空白对照组10只,STC模型组50只,STC模型组大鼠再随机分为通便胶囊低、中、高剂量组、模型对照组、麻仁丸组各10只。造模后观察模型组与空白对照组大鼠血浆P物质(SP)、一氧化氮(NO)水平的比较;通便胶囊治疗2周后,观察模型组各组大鼠体内SP、胃动素(MTL)、NO水平的变化。[结果]造模后模型组较空白对照组SP水平降低、NO水平升高(P0.01);通便胶囊治疗2周后,对SP、NO、MTL水平的影响,低剂量组治疗效果差,疗效无统计学意义,中、高剂量组治疗疗效显著。麻仁丸组与高剂量组、中剂量组比较差异无统计学意义(P0.05),说明通便胶囊中、高剂量疗效确切。[结论]通便胶囊中、高剂量能够使STC大鼠模型体内SP、MTL的水平升高,NO水平降低;具有促进结肠蠕动,增加结肠动力的作用,其作用机制可能与调节胃肠激素水平有关。     

疏肝润肠方防治慢传输型便秘可能机制及效应靶点的探讨

[目的]探讨疏肝润肠方干预慢传输型便秘可能机制及效应靶点.[方法]60只SPF级Balb/c雄性小鼠,按体质量随机分为:正常组、模型组、治疗组(含低、中、高剂量亚组).除正常组外,模型组、治疗组均以复方地芬诺酯灌胃制模.观察所有小鼠排便时间、排便次数及粪重,应用免疫组化SABC法检测Cajal细胞标志物C-kit表达,实时荧光定量PCR技术检测血浆中P物质(SP)和血管活性肠肽(VIP) mRNA表达变化.[结果]模型组大便次数减少、排便时间延长、粪便少而且硬;治疗组较模型组大便次数增加、排便时间缩短、大便性状偏软(P＜0.05).与正常组比较,模型组小鼠结肠黏膜Cajal细胞阳性分布面积及数目减少(P＜0.05).模型组小鼠结肠SP、VIP mRNA表达呈下降趋势;治疗组小鼠结肠SP、VIP mRNA表达呈上升趋势(P＜0.05).[结论]疏肝润肠方可能通过调控SP及VIP的分泌,从而缩短慢传输型便秘小鼠排便时间、增加排便次数及便重、促进小鼠粪便软化,增加肠推进,促进小肠的传输功能而发挥其治疗慢传输型便秘的药效.     

慢传输型便秘乙状结肠VIP,SP免疫组化研究

目的探讨慢传输型便秘（ＳＴＣ）的神经病理学基础。方法应用半定量免疫细胞组织化学的方法，对１４例ＳＴＣ和１１例非梗阻性直肠腺癌患者的乙状结肠标本进行研究，主要观察肠壁内血管活性肠肽（ＶＩＰ）和Ｐ物质（ＳＰ）的变化。结果常规ＨＥ染色下，两组结肠肌间神经丛无明显改变；免疫组化见ＳＴＣ患者乙状结肠壁内ＶＩＰ含量减少（Ｐ＜０．０５）；ＳＰ含量明显降低（Ｐ＜０．００１）；而粘膜层内无明显变化。结论ＳＴＣ患者结肠壁存在明显的神经病理学变化，其结肠传输减慢可能与肠壁内ＶＩＰ和ＳＰ能神经元数量减少和／或功能障碍有关。     

肠神经系统与慢传输型便秘

慢传输型便秘(STC)病因未明,多因素与其发病相关.肠神经系统(ENS)可独立调节肠道功能,其在慢传输型便秘中的改变具有重要意义.此文就此予以阐述,为STC临床治疗提供依据.     

针刺和结肠水疗治疗慢传输型便秘及与VIP、NOS的相关性研究

目的 观察针刺联合结肠水疗治疗慢传输型便秘(STC)的临床疗效,治疗前后主要症状的变化及空腹血浆血管活性肠肽(VIP)、血清一氧化氮合酶(NOS)的变化,并探讨其与结肠运动的关系.方法 选择确诊为STC的患者36例(STC组)给予针刺联合结肠水疗,并设正常对照组30例.采用放射免疫法(RIA)测定STC组治疗前、后空腹血浆VIP的含量,比色法测量计算空腹血清NOS的含量,并与正常对照组比较.结果 STC组临床症状改善,总有效率为88.9%.治疗前血VIP、NOS水平较正常对照组明显增高,差异有显著性(P＜0.05).治疗后血VIP、NOS水平明显降低,与治疗前比较差异有显著性(P＜0.05).结果 表明,针刺联合结肠水疗治疗STC可降低血VIP、NOS水平.结论 针刺联合结肠水疔能明显改善STC患者的临床症状,促进肠蠕动,并能调节血VIP、NOS水平.     

运脾润肠法对慢传输型功能性便秘胃肠激素的影响

目的:观察中医运脾润肠法治疗慢传输型便秘(slow-transit constipation,STC)的临床疗效及对血清一氧化氮(NO)、血浆P物质(SP)水平的影响.方法:选择确诊为STC患者90例随机分为2组,应用秘通治疗60例,莫沙必利治疗30例,并设正常对照组30例,采用放射免疫法(RIA)测定中药治疗组及西药对照组治疗前、后空腹状态血清NO和血浆SP水平.结果:中药治疗组临床症状总有效率为93.3%,西药对照组为73.3%,两组对比有显著性差异(P＜0.05),且前者临床痊愈率为20%,明显高于西药对照组0%(P＜0.05).治疗前,中药治疗组和西药对照组血浆SP水平低于正常组,血清NO水平高于正常组.治疗后,西药对照组NO及SP与正常组对比仍有显著性差异(NO:70.53±9.48 μmol/L vs 62.56±10.01 μmol/L,P＜0.05;SP:30.15±5.25 umol/L vs 34.55±4.39 μmol/L,P＜0.05),而中药组(NO:66.24±14.09μmol/L;SP:34.36±6.35 μmol/L)与对照组无显著差异(P＞0.05).结论:采用中医运脾润肠法治疗STC患者疗效显著,能调节血清NO和血浆SP浓度,推动肠道蠕动,促进肠道排空,从而改善患者临床症状.     

加味五磨饮子治疗慢传输型便秘的疗效及对患者血清P物质、血管活性肠肽、一氧化氮、神经肽Y水平的影响

目的探讨加味五磨饮子治疗慢传输型便秘的临床效果及对患者血清P物质(SP)、血管活性肠肽(VIP)以及肠神经递质一氧化氮(NO)、神经肽Y(NPY)水平的影响。方法选取慢传输型便秘患者82例,随机均衡分为研究组和对照组各41例。研究组给予加味五磨饮子治疗,对照组给予莫沙必利片治疗,疗程均为1个月。观察治疗后患者临床疗效,采用酶联免疫吸附试验法检测患者血清SP、VIP、NO及NPY水平。结果治疗后,研究组总有效率为97.56%,显著高于对照组的78.05%(P0.05);两组患者治疗后大便燥结程度、排便费力程度等症状较治疗前均存在一定程度改善,研究组患者治疗后各项评分低于治疗前和同期对照组(P0.05);治疗后,两组血清VIP、NO和NPY水平均低于治疗前,SP水平高于治疗前(P0.05),且研究组治疗后VIP、NO和NPY均低于对照组,SP高于对照组(P0.05)。结论采用加味五磨饮子治疗慢传输型便秘患者,能够显著缓解患者临床症状,提高血清SP水平,抑制VIP、NO、NPY水平。     

Cajal间质细胞与慢传输型便秘

慢性便秘中近一半属于慢传输型便秘,其病因复杂,机制尚不明了。研究证实Cajal间质细胞是胃肠道的起搏细胞,产生慢波和传导电兴奋,参与神经递质的调节。近期研究表明慢性便秘患者结肠组织中Cajal间质细胞数量减少,形态及其网状结构改变,这在慢传输型便秘发病中具有重要的病理生理学意义。     

慢传输型便秘发病机制的研究

慢传输型便秘(STC)的发病机制主要与肠神经系统(ENS)、Cajal间质细胞(ICC)、平滑肌、神经递质等有关。研究发现STC结肠组织中ENS出现退行性变化,肌间神经丛空泡变性,ICC数量减少,形态改变,平滑肌退行性变,多种神经递质发生改变。本文就STC发病机制的研究作一综述。     

慢传输型便秘外科治疗的主要术式及疗效

近年来,便秘的发病率呈缓慢上升趋势。然而,国际上对于慢传输型便秘的发病原因及发病机理尚未完全认清。虽然经过一段时间的内科保守治疗能够暂时缓解便秘症状,但不能从根本上解决慢传输型便秘的问题。手术可能是最终而有效的治疗慢传输型便秘的方法。现阶段,治疗慢传输型便秘的主要术式有：全结肠切除回直肠吻合术、结肠次全切除盲肠直肠吻合术、结肠旷置术和末端回肠造口术等。本文主要介绍这几种术式及其疗效。     

胶质细胞源性神经营养因子在慢传输型便秘大鼠结肠的表达及其对肠道传输功能的影响

C模型组与STC模型加GDNF组(2.21)相比(P=0.017),GDNFmRNA相对表达水平差异有统计学意义;正常组与STC模型加GDNF组的差异无统计学意义.结论 STC大鼠结肠GDNF的表达下调,在STC发病中起一定作用;STC模型组肠道传输明显减慢,外源性GDNF对肠道传输功能有明显促进作用.     

GI-pill胃肠电子胶囊与结肠运输试验联合检查在慢传输便秘中的应用价值

目的探讨GI-pill胃肠电子胶囊在慢传输型便秘中的应用价值。 方法将81例排除出口梗阻型便秘和肠道器质性疾病,同意接受胃肠电子胶囊检测的慢性便秘患者,数字随机法分为两组,研究组42例,同时口服胃肠电子胶囊和不透X线颗粒胶囊;对照组39例单独口服不透X线颗粒胶囊;口服后2组患者均填写饮食、活动、休息等临床记录表,每隔24小时拍摄腹部X线立卧位平片,直至腹腔残留不透X线颗粒数小于4粒,研究组同时连续观察体外数据记录仪运行状态直至电子胶囊排出体外回收;对照分析2组结肠运输试验结果,统计分析GI-pill胃肠电子胶囊在体时间、胃、小肠、结肠通过时间,HAPCs数量、生理响应比。 结果研究组和对照组结肠运输试验平均时间分别为4.94±1.31天和4.85±1.35天,右半结肠通过时间、左半结肠通过时间及直乙结肠通过时间分别是1.38±0.62天和1.35±0.53天,1.97±0.99天和2.02±0.90天,1.52±0.74天和1.58±0.71天,相比无统计学差异;研究组GI-pill胃肠电子胶囊在体时间与结肠运输试验时间分别为120.0±15.32小时和4.9±1.32天,胃肠电子胶囊在胃、小肠和结直肠的时间分别为5.83±3.12小时、8.75±4.01小时、94.7±17.63小时,HAPCs总数、群发HAPCs和生理响应比分别为14.2±5.14个、4.9±2.26个和39.20%。全体患者研究期间无腹痛、呕吐、黑便等不适表现。 结论GI-pill胃肠电子胶囊可连续评价慢传输便秘患者消化道动力特征,与结肠运输试验有很好的同一性,值得临床推广应用。     

慢传输型便秘发病机制的研究进展

慢传输型便秘(STC)病因未明,多种因素如肠神经系统、肠神经递质、胃肠激素、Cajal间质细胞等与其发病相关。此文就此予以阐述,为STC临床治疗提供依据。     

Results of colectomy for severe slow transit constipation

PURPOSE: This study assesses the outcome of a standardized operation performed by two surgeons for severe idiopathic slow transit constipation that was resistant to laxative treatment. METHODS: Fifty-nine consecutive patients, 4 men and 55 women, with a mean age of 42.3 years, underwent colectomy with ileorectal anastomosis. Slow colonic transit was demonstrated in each case. Fifty-two patients were available for follow-up, with median time to follow-up being 42 (range, 3–81) months. RESULTS: Median bowel frequency was 4 per 24 hours. Sixty-nine percent had four or less bowel movements daily. Ten percent used antidiarrheal medication regularly. One patient had a stoma for recurrent severe constipation. Mean continence score was 1.8 (on a scale of 0–20); six patients were incontinent, and four of these six had normal preoperative anal manometry. Fourteen patients (27 percent) had difficulty with rectal evacuation. Preoperative defecating proctography was a poor predictor of postoperative evacuation difficulties. Twenty-seven patients (52 percent) had persisting abdominal pain, but there was a significant improvement in the degree of pain (P <0.00001). Forty-seven patients (90 percent) were satisfied with the outcome of the operation (and would elect to have it done again). Dissatisfied patients had recurrent constipation or diarrhea and incontinence. CONCLUSION: Colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients undergoing surgery for severe constipation with proven slow colonic transit.Supported by the Division of Surgery and the Colorectal Research Fund.Read at the meeting of the Royal Australasian College of Surgeons, Perth, Australia, May 1995.     

胶质细胞源性神经生长因子与慢传输性便秘

慢传输型便秘(STC)至今病因未明。肠神经系统(ENS)可独立调节肠道功能,其在慢传输型便秘中的改变具有重要意义。胶质细胞源性神经营养因子(GDNF)不仅可促进多种神经元的存活与分化,而且对多种原因造成的神经损伤具有明显的保护作用。此文主要从肠神经系统的功能变化和胶质细胞源性神经营养因子的营养作用这两方面来阐述与功能性便秘之间的相关性。     

Hand-assisted laparoscopic total colectomy for slow transit constipation

Purpose Current medical treatments for slow transit constipation (STC) are often ineffective, and total colectomy with ileorectal anastomosis has been the procedure of choice for selected patients with refractory STC. Today, minimally invasive approaches are being utilized in a greater number of procedures as surgeons become more familiar with the techniques involved. The aim of this study was to assess the safety and utility of hand-assisted laparoscopic total colectomy for STC. Method From January 2002 to December 2005, 44 women presented with complaints of intractable constipation and failed to respond to medical treatment. Slow transit constipation was diagnosed after a series of examinations, including a colonic transit test, anal manometry, balloon expulsion test, and barium enema. All eligible patients underwent a hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Main outcome measures included the operative time, conversion to open procedure, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. Result The mean operative time was 197 min (range, 125–295 min). The mean estimated blood loss was 113 ml (range, 100–300 ml). The mean day of first time to flatus was 2 days, and the mean hospital stay was 7.6 days. There was no conversion to an open procedure and no surgical mortality. In the following period, two patients developed intestinal obstruction, which underwent exploratory laparotomy. However, some 39 patients (88.6%) expressed excellent or good in satisfaction. Conclusion Hand-assisted laparoscopic total colectomy could be a safe and efficient technique in the treatment of STC.