可控式回肠管式造口安全性的组织学研究  

Histological study on the safety of the controllable ileostomy with pipe

作　　者：王襄瑜[1] 许超[1] 陈林昊[1] 黄良祥[1] 曾长青[1] 薛芳沁[1] 郑羽[1] 池良杰 林达佳[1] 谢礼锋 Wang Xiangyu;Xu Chao;Chen Linhao;Huang Liangxiang;Zeng Changqing;Xue Fangqin;Zheng Yu;Chi Liangjie;Lin Dajia;Xie Lifeng(Department of Gastrointestinal Surgery,Provincial Clinical College,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院胃肠外科,福建省立医院胃肠外科,福州350001

出　　处：《中华胃肠外科杂志》2018年第11期1291-1295,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：福建省自然科学基金面上项目(2015J01430).

摘　　要：目的 从组织学层面探讨可控式回肠管式造口技术的安全性.方法 以28只完成可控式回肠管式造口术的比格犬为研究对象,手术于盲肠根部对系膜侧打孔置入带球囊的特制造瘘管,以双线结卡压法前后固定.术后14 d拔除造瘘管后,通过消化道造影及解剖观察初步评估此术式的安全性;将设置缝线卡压处小肠组织作为实验段,近端非缝线卡压处小肠组织作为对照,进一步比较两段犬的小肠标本组织学染色及S-100蛋白、c-kit蛋白和α-平滑肌肌动蛋白(α-SMA)免疫组化染色情况,同时定量比较肌间神经丛、Cajal细胞(ICC)和肠壁平滑肌细胞.结果 术后14 d拔除造瘘管后,实验犬进食及排粪均正常,消化道造影提示肠管通畅,未见明显狭窄及梗阻.术后21 d对实验犬进行解剖,见腹壁窦道口愈合良好,腹腔内窦道形成良好,肉眼下观察实验段小肠血运、形态及运动功能与均近远端非实验段肠管无区别. S-100免疫组化染色显示,实验段与非实验段的S-100蛋白阳性细胞和"空白区"细胞形态及其分布一致;计数肌间神经丛,实验段(3.62± 1.82)个/视野,非实验段(3.27±1.62)个/视野,两组差异无统计学意义(t=1.30,P=0.20). c-kit免疫组化染色显示,两组c-kit阳性细胞的分布一致;对肌间神经丛内的ICC数进行计数,实验段(2.96±2.57)个/神经丛,非实验段(2.49±1.80)个/神经丛,差异无统计学意义(t=1.81,P=0.07).α-SMA免疫组化染色显示:实验段与非实验段小肠组织全层肠壁平滑肌(黏肌层、纵肌、环肌等)细胞形态及分布一致;对环肌层α-SMA染色切片进行平均吸光度值检测并定量分析,实验段为0.15± 0.03,非实验段为0.14±0.04,差异无统计学意义(t=1.16,P=0.25).结论 从组织学角度显示,可控式回肠管式造口技术是安全的.Objective To investigate the safety of the controllable ileostomy with pipe in view of histology. Methods Twenty-eight Beagle dogs undergoing controllable ileostomy with pipe were studied. The special fistula tube with balloon was placed into the hole locating at the cecal root opposing the mesenteric side, and fixed by double knot compression method. Results The fistula tube was removed 14 days after surgery, then the safety of the procedure was preliminarily evaluated by gastrointestinal radiography and anatomical observation. The small intestine tissue at the compression suture was used as the experimental segment, and the small intestine tissue at the proximal non-compression suture was used as the control segment. The histological staining and the immunohistochemical staining of S-100 protein, c-kit protein and α-smooth muscle actin (α-SMA) protein between two segment were compared, while quantitative comparison of myenteric plexus, intestinal Cajal cell(ICC) and smooth muscle cells in intestinal wall was carried out. After removal of fistula tube at 14 days postoperative, the dogs were normal in feeding and defecation. The digestive tract radiography showed that the intestine was patent without obvious stenosis and obstruction. The dogs were dissected 21 days after operation. The abdominal sinus ostium was well healed and the internal sinus was well formed. Under gross inspection, blood supply, morphology and motor function of experimental intestine segment were similar from the proximal and distal segments of control intestine. S-100 immunohistochemical staining showed that the morphology and distribution of S-100 protein positive cells and "blank area" cells in the experimental and control segments were consistent. Myenteric plexus counting showed that the experimental segment was 3.62±1.82/field and the control segment was 3.27 ±1.62/field, whose difference was not statistically significant (t=1.30, P=0.20). Immunohistochemical staining of c-kit showed that the distribution of c-kit positive cells in

关 键 词：直肠肿瘤 组织学 管式造口 可控 安全性 比格犬 

分 类 号：R735.37[医药卫生—肿瘤]