| Objective To research the safety and effect on motility recovery ofgastrointestinal using xiaochengqi mixsture after colonic anastomosis.Methods This study is composed of clinical research and animalexperiment. Part of experimental animal: A total of 60 cleaning wistar ratswere randomly divided into the treatment group(groupâ… ) and the controlgroup(groupâ…¡), each group has 30 rats. After colonic anastomosis, rats ofgroupâ… were received xiaochengqi mixsture as nasal feeding to promote themotility recovery of gastrointestinal after surgery, compared with rats ofgroupâ…¡who were received the same dosage of clear water as nasal feeding too. Toobserve the survival of rats in each group. In case of animal was dead duringthe experiment, we performed exploratory laparotomy immediately to examinethe condition of abdominal cavity, afterward we found out the cause of deathand recorded the mortality. All the rats were received exploratory laparotomyat the third, 7th, 14th days after operation, we took 10 rats from each groupevery time to carry through acute pressure load test, then we got the tissueof anastomotic stoma to make pathological research, moreover the quantitativeanalysis of component of anastomotic stoma was performed by dint ofprofessional image sofeware. Part of clinical research: 106 patients withcolorectal anastomosis were researched in the third general surgery ofGuangzhou University of TCM from March 2004 to November 2006. Inclusioncriteria:â‘ clear consciousness, good comprehension ability, who were acceptedto accomplish the research(signing for the operation approval before surgery);â‘¡only one site of colonic anastomosis. These patients were randomly dividedinto the treatment group(groupâ… ) and the control group(groupâ…¡), Patients of the first group were received primary mixsture (Dahuang 6g(later), Houpu10g, Zhishi 10g, Dangshen 30g) of xiaochengqi by nasal feeding just 4 hoursafter surgery, the speed of dripping is 1ml·min-1, 4 hours later they werereceived secondary decoction of xiaochengqi in the same way. We continued todo these measures at the second day until patients who had the fist defecationwhich indicated the motility recovery of gastrointestinal. In the controlgroup, patients were accepted fasting until fist exhaust or pass stool intraditional way. We begin to record the time of borborygmus, fist exhaust anddefecation 4 hours after surgery. Using the statistical software SPSS13.0database to obtain the result through statistics analysis adopting the T andX2 test.Results Part of animal experiment: 1. The survival ratio of experimentalanimal: There were three animals dead in all, one of them died in the treatmentgroup at the day of surgery(it was fidgety during operation, we superaddedanaesthetic, however it died 2 hours after surgery, the reason may be excessiveanaesthetic). There was one dead of intestinal leakage and celiac infectionat the second day after surgery in the groupâ… , another was dead of ileus,bowel distention and intestinal edema at the third day, the others weresurvival. 2. The condition of anastomotic concrescence: the anastomotic stomaof survival rats healed well, the fraction of anastomotic conglutination intwo groups was 1.26±0.31,1.94±0.36 respectively. There was significantdifference(P＜0.05)between them. 3. Acute pressure load-test of anastomoticstoma: pressure of two groups went up to the 40 mmHg at the 3rd,7th day ofpost-operation and none of them appeared anastomotic dehiscence. We detectedthe fracted pressure of anastomotic stoma at the 14th day after the operation,groupâ… is 139.47±7.05mmHg, and groupâ…¡is 96.71±4.73mmHg, comparing twogroups means by T test, P＜0.01. 4. Pathological research on anastomotic tissue:at the third day of post-operation, the intestinal mucosa of the two groupshad already repaired completely, but gland wasn't prosperous, glandular cavitywas less. Granulation under mucous layer grew actively, there were much morehyperplasia of blood capillary and fibroblast. At the 7th day after theoperation, the mucosal gland of two groups grew well, and it was near to thenormal intestinal mucosa, there were much more granulation in blood capillary,a fraction of them already turned to small blood vessel. At the 14th day afterthe operation, there were ont only hyperplasy in fibroblast, but also collagenous fibers obviously formed around them, but there was thinerfasciculi, sparse arrangement. At the 14th day of post-operation, the mucouslayer of two groups were similar to condition of the 7th day, but bloodcapillary decreased in the granulation tissue, more small vessels formed, andmore collagenous fibers formed surrounding fibroblast compared to the 7thday. The two groups have no significant difference in grosshistological-pathological. But more analysis of collagenous fiber found that:At the third day of post-operation, anastomotic fibroblasts of groupâ… collagen synthesized more actively than groupâ…¡. Collagenous anabolismof two groups reached to peak at the 7th day of post-operation, it also beginedto appear obvious fibrosis, but there was thiner fasciculi, disorganizedarrangement. Compared with groupâ…¡, the amount of anastomotic collagen contentwas much more in groupâ… , Later of the 7th day post-operation, the anabolismof collagen tends to stable, but groupâ… was much more than groupâ…¡in thequantitative analysis, there was significant difference(P＜0.05)between themAt the 14th day post-operation, fiber bundle was quite thick, orderlyarrangemen, but there was no significant difference in the amount ofcollagenous fiber between two groups. The VEGF dye found is that: capillaryhyperplasia of the anastomotic granulation tissue increased quickly aroundthe 3rd day and reached to peak, the density of blood capillary in the groupâ… was bigger than the groupâ… . At the 7th day post-operation, blood capillaryhad no obvious growth conparing with the third day, but some of them alreadyturned tosmall blood vessel, there was no significant difference in the densityof blood capillary between two groups. Compared with the 7th daypost-operation, the amount of blood capillary obviously decreased at the 14thday. Much blood vessel came into being, there was no significant differencein the density of blood capillary between two groups. The research bytransmission electron microscopy: At the 7th day post-operation, the excretivefunction of glandular epithelial cell in groupâ… was active, there were alsoabundant cytoplasm which contained much secretory granule, the glandularepithelial cell adjoined tightly. Compared with groupâ… , there was less activehyperplasia of fibroblasts, less cytoplasm, less secretory granule, inferiorconnection among glandular epithelial cell in groupâ…¡. At the 7th daypost-operation, there were active hyperplasia of fibroblasts, more kytoplasm,abundant cytoplasm, developed cell endoplasm net and mitochondria in groupâ… . Compared with groupâ… , there was also active hyperplasia of fibroblasts,but there were less kytoplasm, not abundant cytoplasm, bigger nucleoplasm andundeveloped cell endoplasm net and mitochondria in groupâ…¡. At the seventh daypost-operation, collagenous fibre obviously formed by the side of fiber cellin groupâ… . The collagenous fibre was long and thin, alternate arrangement,part of them was paratactic. Compared with groupâ…¡collagenous fibre obviouslywas shorter, also it arranged more sparse than groupâ… . The part of clinicalresearch: there were no sever complications such as anastomotic leakage inall the patients, three had ileus and one had dehiscence of incision incombination with ileus in groupâ…¡, patients in groupâ… were distinct betterthan groupâ…¡such as the time of borborygmus, fist exhaust and defecation,and so no.Conclusion It is effectively and safely of xiaochengqi mixture to promote themotility recovery of gastrointestinal after colonic anastomosis. |
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