腹部外科手术操作对大鼠肠道运动功能和肠神经系统的影响  

Effect of abdominal surgery on enteric motor function and enteric nervous system in rat

作　　者：张军明[1] 任艳华[1] 郑膺[1] 张婵[1] 刘芬[1] 余正平[2] 雷亚宁[1] 

机构地区：[1]温州医学院组织胚胎学教研室,浙江温州325035 [2]温州医学院附属第一医院外科

出　　处：《解放军医学杂志》2007年第2期127-130,共4页Medical Journal of Chinese People's Liberation Army

基　　金：温州市科技局科研基金资助项目(Y2006A020)

摘　　要：目的观察不同的腹部外科手术操作对大鼠肠道运动功能以及肠神经系统内乙酰胆碱酯酶(AchE)神经元和一氧化氮合酶(NOS)神经元的影响,探讨腹部外科手术对肠道运动功能影响的神经机制。方法48只SD大鼠随机分为单纯开腹组、肠道按摩组、肠道手术组和正常对照组(n=12),各组术后灌服炭末,测定小肠炭末推进率,同时取各组相同部位的小肠和大肠,制作肠肌间神经丛铺片标本,采用AchE和NADPH-d组化染色观察AchE、NOS阳性神经元的分布密度和染色情况。结果炭末推进率(%)肠道手术组、肠道按摩组低于单纯开腹组和正常对照组(P<0.01),肠道手术组低于肠道按摩组(P<0.05),单纯开腹组与对照组比较降低不明显(P>0.05);与正常对照组比较,肠道手术组、肠道按摩组的小肠和大肠肌间神经丛内AchE阳性神经元数量(个/200倍视野)减少(P<0.01),阳性表达减弱,NOS阳性神经元数量增多(P<0.01),阳性表达增强,节间束纤维粗大,而单纯开腹组的变化不明显;与肠道按摩组比较,肠道手术组小肠和大肠肌间神经丛内的NOS阳性神经元数量较多(P<0.01),胞体大而染色深,节间束纤维较粗大,而AchE阳性神经元数量和染色的差异不明显。结论腹部外科手术在一定程度上会影响或损伤肠神经系统的胆碱能和氮能神经,这可能是腹部外科手术后发生肠道运动功能障碍的神经机制之一。Objective To observe the changes in enteric motor function and acetylcholine esterase （AchE） neuron and nitric oxide synthase neuron （NOS） in enteric nervous system after different abdominal operations, and to explore the mechanism of these changes. Sprague Dawley rats were divided into experimental groups （laparotomy group, intestine massage group and intestinal operation group） and the control group. Rats in each group were garaged with medicinal carbon powder, and then the transimission of carbon powder in small intestine was determined, and the spreading specimens of intestinal myenteric plexus of small intestine and large intestine were collected and stained with AchE and nicotinarnide-adenine dinucleotide phosphate-D （NADPH-d） for histological study, and the density of distribution and positive stained AchE and NOS neurons were observed and compared. Results The changes in enteric motor function： the propellant rate of carbon powder was slower in enteric massage group and intestinal operation group than that in laparotomy group and control group （18. 1±2. 8, 25. 7±3. 5 vs 47. 4±3. 6, 49. 8±4. 5, P〈0. 01） ; the propellant rate of carbon powder was slower in intestinal operation group than that in intestine massage group （P〈0. 05） ; no significant difference was found between laparotomy group and control group （P〉0. 05）. Compared with the control group, the number and positive expression of AchE positive neuron in intestinal myenteric plexus decreased in small intestine and large intestine in intestinal operation group and intestine massage group （small intestine 43.0±3. 0, 52. 2±3. 3 vs 65. 3±3. 9, P〈0. 01; large intestine 41.3±2. 6, 50. 8±3. 2 vs 63. 5±3. 8, P〈0. 01）, but the number and positive expression of NOS positive neuron increased （small intestine 50. 5±2. 8, 40. 7±2. 9 vs 27. 8±3. 9, P〈0. 01; large intestine 53. 3±2. 7, 44. 8±3. 1 vs 31.2±3. 6, P〈0. 01）, while no significant changes were found in laparotomy group; The number of NO

关 键 词：消化系统外科手术 肠肌丛 胆碱能神经元 氮能神经元 肠神经系统 

分 类 号：R656[医药卫生—外科学]