慢传输型便秘大鼠胃肠黏膜5-羟色胺3受体的表达

目的:研究5-羟色胺(5-hydroxytryptamine,5-H T)3受体在慢传输型便秘(slow transit constipation,STC)大鼠胃肠黏膜的表达,探讨其在慢传输型便秘中的发病机制.方法:将24只健康Wistar大鼠随机分为实验组及对照组,实验组予以复方苯乙哌啶混悬液[8 mg/(kg·d)]灌胃建立慢传输便秘模型,对照组予以等剂量的生理盐水灌胃.每5d记录1次大便粒数、大便干质量及大鼠体质量.饲养90 d后停药1 wk,判断模型是否成功.采用实时荧光聚合酶链反应法(Real-time PCR,RTPCR)检测5-HT3受体在慢传输型便秘模型大鼠胃、小肠及结肠的表达.结果:通过比较实验组及对照组的日均粪便粒数、平均每粒粪便质量及首粒黑便排出时间可判断造模成功.RT-PCR能特异性扩增5-HT3受体,5-HT3受体在慢传输型便秘大鼠胃、小肠、结肠组织中的表达均低于正常对照组(0.744±0.065,P<0.05;0.294±0.044,P<0.001;0.16±0.027,P<0.001).结论:慢传输型便秘大鼠胃肠黏膜存在5-HT3受体表达下调,其可能与STC发病机制有关.     

慢传输型便秘结肠动力学研究

随着社会人口老龄化的趋势 ,饮食结构的改变以及精神心理和社会因素等的影响 ,慢性便秘已成为影响现代人特别是老年人生活质量的重要病症[1] 。但对慢性便秘的发生机制迄今为止并非完全阐明 ,泻剂导致的泻剂性肠病已引起胃肠科医生的关注。本研究通过对结肠慢传输型便秘结肠动力学特点的评估 ,旨在为这类患者的诊断和治疗策略的选择提供理论和实验室依据。一、材料和方法(一 )研究对象 :5 0例功能性慢性便秘病人 (ｃｈｒｏｎｉｃｆｕｎｃｔｉｏｎａｌｃｏｎｓｔｉｐａｔｉｏｎ ,ＣＦＣ)来自我院胃肠动力中心 (1996～1999年 ) ,并符合以下条…     

不同类型一氧化氮合酶在慢传输型便秘大鼠结肠中的表达

目的探讨不同类型一氧化氮合酶在慢传输型便秘（STC）大鼠结肠的表达。方法健康Wistar大鼠32只,随机分为STC组、对照组,每组16只。采用复方苯乙哌啶灌胃法制备STC大鼠模型,饲养100天后,采用活性炭灌胃法测定肠道传输速度确定模型建立。用免疫组织化学方法分别检测诱导型一氧化氮合酶（iNOS）、神经型一氧化氮合酶（nNOS）及内皮型一氧化氮合酶（eNOS）在大鼠结肠的表达情况。结果 STC组大鼠肠道传输速度与对照组相比明显减慢,首粒黑便排出时间为（686±57）min,较对照组大鼠（608±46）min显著延长（P〈0.05）。免疫组化结果显示,iNOS在STC大鼠结肠的表达明显强于对照组（P〈0.05）;eNOS、nNOS的表达与对照组比较均无明显差异（P〉0.05）。结论 iNOS在STC大鼠结肠的表达异常,表明iNOS在慢传输型便秘发病机制中可能起重要作用。     

结肠慢传输型便秘的手术治疗

结肠慢传输型便秘（slow transit constipation，STC）是以结肠运动功能减弱为特征的一类顽固性便秘，表现为粪便在结肠中的传输速度异常减慢，无便意，大便次数明显减少，以往均为单纯的内科保守治疗，对重症者治疗较为棘手且效果不佳。我科自1999年1月至2006年1月对58例STC患者采用了手术治疗，效果良好，现报告如下。     

血红素氧合酶2在吗啡诱导的结肠慢传输型便秘小鼠结肠中的表达及意义

目的:探讨血红素氧合酶2(HO-2)在吗啡诱导的结肠慢传输运动小鼠近端结肠组织中的表达,和其在慢传输型便秘发生发展中的作用.方法:将48只小鼠随机分为实验组A,实验组B和对照组,每组16只.实验组小鼠sc不同剂量吗啡,实验组A:2.5 mg/(kg·d)和实验组B:3.5 mg/(kg·d),共45 d,建立肠道慢传输运动小鼠模型,对照组以等量生理盐水处理;45 d后各组小鼠随机处死一半.剩余小鼠分别对应作为实验组A2,实验组B2和对照组2,不作处理观察15 d,再全部处死.用免疫组化技术比较各组小鼠近端结肠组织中HO-2阳性细胞的表达情况.结果:在实验组和对照组小鼠结肠组织中HO-2均有表达;实验组较正常组表达显著减少:实验组B较实验组A的表达明显减少;停用吗啡观察15 d后各实验组较45 d时各实验组表达明显减少.结论:吗啡诱导的肠道慢传输运动小鼠结肠组织中HO-2表达显著减少,并与吗啡剂量和时间有关,提示抑制性神经递质CO异常减少可能是肠道慢传输运动的病因之一.     

慢传输型便秘动物模型研究进展

慢传输型便秘（slowtransitconstipationSTC）是一种以结肠通过时间延长和结肠动力下降为特征的顽固性便秘,是功能性便秘中常见的类型。随着人们饮食结构、生活习惯以及精神心理等因素的影响,其发病率呈逐年上升趋势。美国一项回顾性研究发现STC占慢性便秘患者的42．0%,是慢性便秘常见的病理类型。国内流行病学调查显示,     

慢传输型便秘分子机制研究及临床应用现状

慢性便秘是最常见的胃肠道症状之一,而慢传输型便秘是各类型慢性便秘中最难治疗的,慢传输型便秘以结肠传输延迟为特征,无出口梗阻,当药物难以治疗后,则需要结肠切除术或次全切术。慢传输型便秘病因机制复杂,致病机制目前尚未明确,研究主要集中于肠道神经系统的病理改变、胃肠Cajal间质细胞改变、神经递质和胃肠激素的异常、肠内液体吸收等的影响。现在许多新的研究方法蓬勃发展,有希望为慢传输型便秘发病机制的深入研究提供新的思路。     

慢传输性便秘结肠阿片受体的病理生理改变

目的 为了更加深入地了解慢传输性便秘的发病机理和病理生理改变。方法 应用放射配体结合分析检测了患结肠mu、Kappa阿片受体含量变化。结果 与正常对照组比较,STC患结肠壁肌层ma、Kappa阿片受体含量增加。结论 STC患内源性阿片肽活性增加,肠道运动受抑制,提示阿片受体拮抗剂可能是治疗STC的一个新途径。     

慢传输型便秘的临床研究进展

在晚近胃肠动力学的研究中 ,医学界趋于将便秘分为慢传输型便秘 (Ｓｌｏｗｔｒａｎｓｉｔｃｏｎｓｔｉｐａｔｉｏｎ ,ＳＴＣ)、出口梗阻型便秘和两者的混合型便秘。对于出口梗阻型便秘是作为一个症状而存在于某种疾病当中的 ,它多与盆底疾病相关 ,应用排便造影、肛门直肠测压和电生理检查 ,可明确诊断。针对这些疾病的治疗 ,排便功能失调的解决 ,便秘症状可相应缓解。除了上述容易通过容积性泻药治疗的和可治性肛门直肠疾病 ,剩下的则就是怀疑结肠动力受损所引起的结肠传输功能异常 ,即结肠无力 ,使粪便在肠道停留时间过长的便秘 ,即ＳＴＣ…     

Abnormalities of nerve fibers in the circular muscle of patients with slow transit constipation

Abnormalities of the enteric nervous system are thought to explain the pathophysiology of motility disorders. Our aim was to determine if particular classes of enteric neurons are affected in slow transit constipation (STC). Specimens were taken from the terminal ileum and ascending, transverse and descending colon of patients undergoing subtotal colectomy for STC. Immunohistochemistry was performed using antisera to neuron-specific enolase, tachykinin, leu-enkephalin, choline acetyltransferase, vasoactive intestinal peptide, nitric oxide synthase, tyrosine hydroxylase and neuropeptide Y. The density of nerve fibres labelled with these antibodies in each layer was compared with age-matched controls. The density of nerve fibres with tachykinin and enkephalin immunoreactivity was reduced in the colonic circular muscle of the 15 patients with STC, whereas innervation of all other layers was normal. This reduction of tachykinin-immunoreactive nerve fibres also occurred in nine of the 12 specimens of terminal ileum examined. No difference was detected in the density or distribution of nerve fibres using the other antisera. Excitatory nerve fibres are present in the circular muscle in STC but they are deficient in tachykinins and enkephalin. Accepted: 14 January 1998     

Decreased interstitial cells of Cajal in the sigmoid colon of patients with slow transit constipation

Background and aims Slow transit constipation (STC) is a colonic motor disorder that is characterized by measurably delayed movement of materials through the colon. Although abnormalities in the neuronal networks of the colon have been demonstrated in patients with STC, the etiology of STC remains unclear. Interstitial cells of Cajal (ICC) have been shown to be the pacemaker cells of the intestine and have been implied in the pathogenesis of a number of gastrointestinal motility dysfunctions, including idiopathic STC. This study aimed to determine the normal distribution of ICC within the colon of the Chinese and also to determine if ICC are decreased in Chinese STC patients.Patients and methods Twelve patients with STC and eight age-matched normal controls were studied. Specimens of sigmoid colon were obtained immediately after resection. ICC were identified with a monoclonal antibody to c-kit by an indirect immunofluorescence method. Immunostained tissues were examined with a laser scanning confocal microscope and the area occupied by ICC was calculated with an image analysis system.Results ICC were located in the external muscle layers including myenteric plexus (MP) and submucosal border (SMB). Two types of Kit-positive ICC were observed: bipolar cells characterized by one or two long processes and multipolar cells characterized by long stellate processes extending in various directions. A higher percentage of ICC was present in the MP regions and circular muscle (CM) layers compared with the SMB and longitudinal muscle (LM) layers. Tissues from STC patients showed a considerable decrease in the number of ICC located in the four regions (ICC-LM, ICC-MP, ICC-CM, ICC-SMB), especially the ICC-SMB, in which ICC almost completely disappeared.Conclusions Similar distribution of ICC was observed in the normal sigmoid colon of the Chinese. Decreased area of c-kit+ ICC may play an important role in the pathophysiology of STC. It remains to be determined whether the loss of ICC is primary or secondary to another lesion.     

慢传输型便秘结肠次全切除术后盲肠直肠吻合方式的探讨

目的探讨慢传输型便秘行结肠次全切除术后更合理的盲肠直肠吻合方式。 方法对兰州军区兰州总医院连续收治并进行手术治疗的34例STC患者的临床资料进行回顾性分析,男性3例,女性31例;年龄36～75岁,平均60.5岁。所有患者均选择行结肠次全切除盲肠直肠吻合,手术在常规开腹或是腹腔镜辅助下进行,盲肠直肠吻合方式采用回盲瓣对侧的盲肠侧壁与直肠残端进行端侧吻合。 结果传统开腹施行手术18例,腹腔镜辅助手术16例。术后1～3天开始排便,6～20次/d,术后第5-6天时排便次数逐渐减少。22例患者在术后10天时大便次数减少至8次/d以内;10例患者术后出现稀水样便伴肛门疼痛,经口服易蒙停、思密达等对症处理后好转。术后发生吻合口瘘1例、切口感染5例、尿潴留2例、炎性肠梗阻2例。30例患者得到随访2月至8年,大便次数保持在1-6次/d。2例患者7年后诉肛门坠胀,排便不净感。1例患者于术后4.5年时出现不完全性肠梗阻,经保守治疗后痊愈。27例患者术后立即感觉治疗效果满意,占80%;随访过程中,所有患者自觉症状均较术前改善明显,对手术治疗满意。无围手术期死亡。 结论对于确实需要手术治疗的STC患者,结肠次全切除盲直端侧吻合可以作为术式选择之一。     

针刺治疗老年慢传输型便秘60例临床观察

目的 观察针刺治疗老年慢传输型便秘的疗效及对肠动力的影响.方法 随机将60例老年慢传输型便秘患者分为两组,其中,实验组：30例老年患者运用针刺治疗,每日1次,每次30分钟.对照组：30例给予口服莫沙必利治疗,每次5mg,每日三次.两组均共治疗2周.结果 实验组30例,痊愈14例（46.67％）,有效15例（50％）,无效1例（3.33％）,总有效率96.67％;对照组30例,痊愈8例（26.67％）,有效16例（53.33％）,无效6例（20％）,总有效率80％,实验组疗效优于对照组,两组差异有统计学意义（P＜0.05）.结论 针刺治疗老年慢传输型便秘具有较好的临床疗效,并能有效促进肠蠕动.     

艾灸联合穴位注射对慢传输型便秘患者胃动素的影响

目的:研究艾灸联合穴位注射治疗慢传输型便秘的临床疗效及其对慢传输型便秘患者胃动素(MLT)的影响,探讨其治疗慢传输型便秘的可能机制.方法:将符合纳入标准的56例慢传输型便秘患者随机分为观察组和西药组.同时选取正常体检志愿者28人作为正常对照组.西药组患者给予莫沙比利10 mg口服,3次/d,共20 d.观察组患者给予双...     

慢传输型便秘大鼠结肠诱导型一氧化氮合酶和血红素氧合酶2的变化

目的 探讨慢传输型便秘(STC)大鼠结肠内诱导型一氧化氮合酶(iNOS)和血红素氧合酶2(HO-2)的变化.方法 健康Wistar大鼠32只,随机分为STC组和对照组,每组16只.采用复方苯乙哌啶灌胃法制备STC大鼠模型,饲养100 d后,采用活性炭灌胃法测定肠道传输速度确定模型建立.用免疫组织化学方法分别检测iNOS和HO-2在大鼠结肠的表达情况.结果 STC组大鼠日均粪便粒数、日均粪便干重、日均粪便质量均比对照组明显减少;检测大鼠肠道传输速度,STC组较对照组明显减慢,首粒黑便排出时间较对照组显著延长.iNOS和HO-2在STC大鼠结肠的表达明显强于对照组.结论 iNOS和HO-2在STC大鼠结肠的表达异常,表明iNOS和HO-2在慢传输型便秘发病机制中可能起着重要的作用.     

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.     

大鼠胃肠道不同部位Cajal间质细胞与慢传输型便秘的关系

目的观察慢传输型便秘(slow transit constipation,STC)大鼠模型胃肠道Cajal间质细胞(interstitial cell of cajal,ICC)的分布特点与含量改变,全面评估ICC在STC发病机制中的作用。方法 24只健康Wistar大鼠随机分成便秘组和对照组,分别饲喂含复方苯乙哌啶的混悬液和生理盐水,每5 d记录1次大鼠大便粒数、大便干质量及大鼠体质量。饲养90 d后停药1周,测定胃肠道传输功能并通过免疫组化的方法测定ICC的特异性标志物c-kit+细胞在胃窦、小肠、结肠的分布情况与含量变化。结果便秘组日均粪便粒数少于对照组(P<0.01),平均每粒粪便质量大于对照组(P<0.05);便秘组首粒黑便排出时间长于对照组(P<0.05);与对照组比较,便秘组胃窦部位c-kit+细胞数量无明显变化(P>0.05)。而c-kit+细胞在便秘组大鼠小肠、结肠的数目均少于对照组(P<0.05)。结论在STC模型中,胃窦ICC变化不明显,小肠ICC数量有减少趋势,可能对STC有一定影响,结肠部位ICC数量明显减少,可能是慢传输型便秘大鼠的主要病理生理机制。