成形括约肌在不同方式电刺激下功能和形态变化的实验研究  

The changes of function and morphology of the neosphincters following electrical stimulations in dogs

作　　者：张延冲[1] 王广宇[2] 陈亚军[1] 高永杰[1] 张金哲[1] 

机构地区：[1]首都医科大学附属北京儿童医院外科,北京100045 [2]济南市儿童医院外科

出　　处：《中华小儿外科杂志》2007年第12期650-654,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨动力性腹直肌制备括约性肠造瘘的可能性和不同的电刺激方法对成形括约肌形态和功能的影响。方法取10只中国杂种犬,随机分为3组:对照组、肌肉刺激组和肠腔刺激组。电刺激前后,分别测量瘘口肠腔内基础压力(静息压力)和电刺激下的压力、肌肉痉挛最低频率(融合频率)、灌肠保留时间。电刺激结束后,取成形括约肌进行肌球蛋白ATP酶染色,评估Ⅰ型肌纤维的变化.HE染色了解组织结构的变化。结果电刺激训练后,肠腔内静息压力增加(P>0.05);5伏的电刺激下,肠腔内压力能达到60mmHg;肌肉融合频率下降(P<0.05)。在非电刺激和电刺激状态下,动物灌肠保留时间延长(P<0.05),同组动物,电刺激状态下较非电刺激状态下灌肠保留时间延长(P<0.05)。腹直肌经电刺激训练后,Ⅰ型肌纤维比例上升,B组与对照组间比较,差异有统计学意义(P<0.05)。电刺激后,HE染色见肌细胞萎缩,血管成分增多。肌肉及其围绕的肠壁结构无坏死。结论腹直肌成形瘘口括约肌后,电刺激状态下,肠腔内压力能达到控制排便的60mmHg。经直接肌肉电刺激和肠腔内电刺激训练,肌肉Ⅰ型纤维增加,腹直肌能具有括约肌的功能,肌肉及瘘口肠壁结构无损害。Objective To establish a continent stoma by rectus abdominis sphincteroplasty and electrical stimulations. Methods Ten mongrel dogs were randomized into three groups. In group A （control group）,a stoma sphincter was constructed from transplanted right rectus abdominis muscle wrapped around the Thiry-vella loop （a isolated loop of distal ileum both ends exteriorized）. In group B, the electrodes were attached to stromal sphincters near the entry point of the intercostal nerves. In group C, the electrodes were placed in the Thiry-Vella loop. Before and after electrical stimulations, the base-line intraluminal pressure, the intraluminal pressure during electrical stimulation, the minimum stimulation frequency required to produce a fused contraction （the fusion frequency） , and the retention time of the testing enema were recorded. After the completion of the electrical stimulation, the specimens from the neosphincters and left rectus abdominis were procured for the actomyosis ATPase and HE staining. Results After electrical stimulations, the intralu, minal pressure increased moderately （P〈0.05）. The intraluminal pressure reached 60 mmHg which was adequate for continence by a stimulation of 5 V electricity. The fusion frequency decreased （P〈0. 05）. The retention time of testing enema was longer than that of pre-training period （P〈0. 05）. During electrical stimulations,the retention time of testing enema was longer than that of control （no-stimulation）. The electrically stimulated specimens revealed higher proportion of type Ⅰ muscle fibers （P〈0. 05 in group B vs control）. The HE staining revealed atrophy of muscle fiber, reduction of intra-nuclear distance, but no structural change. Conclusions The intraluminal pressure increased and was adequate for continence after the rectus abdominis sphincteroplasty and electrical stimulations. The fast-contracting fatigue-prone type Ⅱ fibers were transformed into the slow-contracting and fatigue-resistant type Ⅰ fibers by the intramu

关 键 词：大便失禁 电刺激 腹直肌 

分 类 号：R-331[医药卫生]