Colonic transit time--what is normal?

Background

Constipation is a common problem in childhood, and various radiologic methods have been advocated for investigation. Colonic transit time (CTT) has been used in adults to investigate colonic motility, but few studies evaluate this method in children. Data on CTT in the normal paediatric population are scarce.

Methods

The colonic transit time was measured in 22 healthy children (median age, 10 years; range, 4 to 15 years) by Abrahamsson’s method. Children took bolus ingestions of radiopaque markers on 6 consecutive days, and on day 7 a single abdominal x-ray was performed. This was evaluated for total and segmental colonic transit time.

Results

The mean total CTT was 40 hours, and the upper limit of normal (95th percentile) was 84 hours. The upper limit of normal for segmental transit time was as follows: 14 hours for the ascending, 33 hours for the transverse, 21 hours for the descending, and 41 hours for the rectosigmoid colon.

Conclusions

CTT provides an objective measure to assess childhood constipation. To date, 6 studies using 5 different methods have been published reporting values for healthy children. Comparing these, Abrahamson’s method has low radiation exposure and is well tolerated. This study contributes additional normal values in children.     

Scintigraphic assessment of slow transit constipation with special reference to right- or left-sided colonic delay

OBJECTIVE: Subtotal colectomy and ileorectal anastomosis for slow transit constipation has several side-effects. The motor abnormality in some patients may be segmental which could motivate a limited resection of the colon. Therefore a diagnostic tool to identify a segmental colonic motor dysfunction is needed. The aim of this study was to evaluate a scintigraphic method to assess colonic transit with special reference to right- or left-sided delay. METHODS: Twenty-three constipated patients (19 women, mean age 50 years) with slow colonic transit on radio-opaque marker studies and 13 healthy individuals (11 women, mean age 46 years) were studied. All subjects were examined with oral (111)Indium-DTPA scintigraphy. The scintigraphic results for patients and controls were presented as geometric centre of radioactivity and percent activity over time in the right, the left and the recto-sigmoid colon. The inter-observer variation in the interpretation of the scans was also evaluated. RESULTS: There was no difference in transit time between the groups of patients and controls in the right colon whereas the patients had a significant delay in the left colon (P < 0.05). Two patients had a marked delay in the right colon followed by relatively rapid transit in the left colon. The inter-observer correlation was good comparing the right, the left and the recto-sigmoid colon (r = 0.58-0.98, P < 0.01-0.001). CONCLUSION: The results indicate that colonic scintigraphy with oral (111)Indium-DTPA may help to select patients for a left or, in a few cases, a right hemicolectomy for slow transit constipation.     

运脾颗粒对脾虚型慢传输型便秘小鼠SP和VIP含量的影响

为观察运脾颗粒对脾虚型慢传输型便秘小鼠肠道传输功能及结肠组织中P物质（sP）和血管活性肠肽（VIP）含量的影响,探讨运脾颗粒治疗脾虚型慢传输型便秘的药效与机制,为该药治疗便秘提供科学依据。采用复合造模法建立小鼠脾虚型慢传输型便秘模型,将小鼠分为空白对照组（A组）、模型对照组（B组）、麻仁对照组（c组）、运脾颗粒大剂量组（D组）、运脾颗粒中剂量组（E组）、运脾颗粒小剂量组（F组）,分别灌服相应药物,末次灌胃后测量肠道墨汁推进率;按放射免疫试剂盒方法分别测出结肠组织匀浆中SP、VIP的含量。结果显示,运脾颗粒能明显提高小鼠肠道传输功能,D组效果优于C组（P〈0．05）。运脾颗粒可明显增加便秘模型小鼠结肠组织中SP及VIP的含量,D、E、F组均优于c组（P〈O．05）,D组最明显（P〈0．01）。结果表明,运脾颗粒能明显提高小鼠肠道传输功能,且各项指标均优于C组（P〈0．05）,其机制可能是通过升高慢传输型便秘小鼠结肠中SP及VIP的含量来提高肠道传输功能。     

Pinealectomy Does Not Affect the Healing of Experimental Colonic Anastomoses

Gastrointestinal system anastomoses, especially colonic anastomoses, have significant morbidity and mortality despite recent technical improvements. Besides regulating the circadian rhythm, the pineal gland and its main neurohormone product melatonin have widespread actions in the organism. The purpose of this study was to investigate the effects of pinealectomy on the healing of colonic anastomoses. One hundred male albino Wistar rats were used in this study. The rats were separated into three groups: control, pinealectomy, and sham groups. In the control group, only colonic resection and anastomoses were performed. Following pinealectomy, colonic anastomosis was performed 2 weeks later on one half and 2 months later on the other half of the pinealectomy group. Only craniotomy was performed on the sham group, and the rats were separated and evaluated like the pinealectomy group. Colonic anastomoses were evaluated on postanastomotic day 3 and 7 by measuring the bursting pressure and the hydroxyproline levels in the anastomotic segments. There was no difference in the bursting pressure measurements between the groups on both postoperative day 3 and 7. Although hydroxyproline levels were different between groups on both postanastomotic days 3 and 7, it has been observed that neither normal nor anastomotic hydroxyproline levels influenced the anastomotic bursting pressure measurements. The percent deviation from the normal values was compared in the anastomotic segments, and no differences were found regarding the bursting pressure and hydroxyproline levels. It was concluded that pinealectomy has no effect on the healing of colonic anastomoses.     

Abstracts

Abstract

The efficacies of four bowel care regimens (bisacodyl suppositories, glycerin suppositories, mineral oil enemas and docusate sodium mini-enemas) were compared in seven subjects with traumatic spinal cord injury. Efficacy was assessed in terms of colonic transit time, bowel evacuation time and subjective responses to a questionnaire. Both docusate sodium mini-enemas and mineral oil enemas decreased total and left-sided colonic transit time. However, docusate sodium mini-enemas were superior to mineral oil enemas in terms of the decrease in bowel evacuation time and symptom reduction. Results in this small group of subjects suggest that docusate sodium mini-enemas may have advantages in the management of bowel evacuation in individuals with spinal cord injury. (J Spinal Cord Med 1998;21 -24)     

自制气囊引流管行结肠旁路引流治疗医源性结肠穿孔

目的探讨采用自制气囊引流管行结肠旁路引流在医源性结肠穿孔患者中的临床应用价值。方法回顾性分析2009年1月至2011年3月间哈尔滨医科大学附属第二医院消化内科采用自行设计的结肠气囊引流管治疗的8例医源性结肠穿孔患者的临床资料。所有结肠穿孔在内镜下金属夹和（或）尼龙绳缝合后。将自制气囊引流管在内镜直视下留置于肠腔内．引流管前端气囊充气后固定于穿孔部位的近口侧．后端固定于患者臀部并行持续引流肠液及粪便。结果8例患者气囊引流管均成功放置并引流通畅．穿孔均完全愈合．无中转外科手术病例。气囊引流管旁路引流时间3-10（平均7．6）d,1例患者术后3d复查结肠镜,发现气囊导管移位,予以内镜下校正。所有8例患者气囊引流管均顺利拔除。拔除后肠壁气囊固定部位无溃疡穿孔发生。术后随访12-36（平均25．4）个月,全组患者术后无慢性肠瘘、粘连性肠梗阻或腹腔感染等并发症发生。结论应用自制气囊引流管行结肠旁路引流治疗医源性结肠穿孔简单、安全并可靠。     

结肠冗长症27例的诊断及治疗

目的 探讨结肠冗长症的早期诊断及有效治疗方法,以减少误诊,缩短确诊前的就医时间.方法 回顾性分析解放军第117和322医院普外科2005年2月-2011年12月收治的27例结肠冗长症患者的病例资料.结果 27例患者临床症状主要为早期反复出现的顽固性便秘、腹胀、腹痛、消瘦等,容易被误诊.除3例患者因乙状结肠冗长症并发扭转急诊入院手术外,24例症状持续,反复多处就医长达2～32年.经门诊钡灌肠造影确立诊断,手术切除病变肠段,随访7～11个月,患者腹胀、腹痛、便秘、消瘦等全身症状消失.结论 本病较少见,要提高医务人员对本病的认识.钡灌肠X线检查是诊断本病的最好方法.确诊后外科手术是治疗最有效措施.     

经脐单孔腹腔镜右半结肠切除术手术路径的程序化

目的:探讨单孔腹腔镜辅助右半结肠切除术手术路径的程序化,以提高手术效率,缩短手术时间,减少术中出血量。方法:回顾分析2009年12月至2011年11月40例单孔腹腔镜右半结肠切除术的临床资料,详细总结右半结肠的游离步骤,以手术时间及术中出血量作为评估指标,从而证实此手术路径的可行性。结果:40例均顺利完成手术,无一例中转开腹,手术时间90～240 min,术中出血量10～100 ml,术后患者满意度较好。结论:通过将手术步骤程序化,手术组成员可在较短的时间内熟悉整个操作过程,配合更加默契,明显缩短了手术时间,减少了术中出血量,手术过程更流畅。     

Vpr对人结肠癌细胞的抑制作用及其机制

目的 探讨人类免疫缺陷病毒1型( HIV-1)病毒蛋白r(Vpr)对人结肠癌细胞HCT-8的抑制作用及其机制.方法 将细胞分为空白对照组、空载体转染组和Vpr转染组.空白对照组:细胞不予干预;空载体转染组:对数生长期的细胞加入不同感染复数(MOI)的空载体腺病毒;Vpr转染组:加入不同MOI的含有HIV1-Vpr基因的重组腺病毒(Adv-Vpr).应用MTT比色法检测细胞增殖活性,流式细胞仪检测细胞周期、细胞凋亡及线粒体膜电位,Western blot法检测细胞凋亡相关蛋白的表达.多组间均数比较采用单因素方差分析,两两比较采用q检验;或采用双因素方差分析,组内比较采用t检验.结果 Vpr显著抑制人结肠癌细胞HCT-8增殖,Adv-Vpr转染72 h后(MOI=200),Vpr转染组细胞MTT值为1.03±0.04,与空载体转染组(2.46 +0.15)及空白对照组(2.51±0.14)比较,差异有统计学意义(F=144.6,P＜0.05);Adv-Vpr转染48 h后(MOI=200),Vpr转染组处于G2/M期的细胞比例及线粒体膜电位下降的细胞比例增加,分别为37.31％±5.90％和32.07％±5.64％,与空载体转染组(18.30％±6.04％、3.32％±0.79％)及空白对照组916.66％±3.51％、2.76％±1.43％)比较,差异有统计学意义(F=10.08,64.45,P＜0.05).Adv-Vpr转染72 h后(MOI=200),Vpr转染组细胞凋亡率为37.62％±6.48％,与空载体转染组(3.44％±1.11％)及空白对照组(2.93％±1.07％)比较,差异有统计学意义(F=122.4,P＜0.05).Adv-Vpr处理48 h后(MOI=200),Westem blot检测发现Vpr导致了Caspase-9、Caspase-3剪切为活性片段,p-Chk1-S345磷酸化增加,而Fas、Fas-L、ERK1及ERK2表达未见上调.结论 Vpr在体外能够有效抑制结肠癌细胞株HCT-8增殖,并诱导其细胞周期G2期阻滞及凋亡,其机制分别与DNA损伤信号通路激活及线粒体凋亡通路启动有关.Vpr在结肠癌的治疗中具有潜在的应用前景.     

腹腔镜中间入路扩大右半结肠癌D3根治术

Lapareseopic colectomy is commonly performed,but laparoscopic extended right hemicolectomy with D3 lymphadenectomy for cancer located at hepatic flexure of the colon is a complex procedure,even in the ...