Experiment And Clinical Research On The Effects Of Colonic Adaptation In Short Bowel Syndrome

Objective: Observe and evaluate the morphological adaptation hyperplasiaand the change of nutrition functional absorption of the SD rats'remaining colon after total small intestine resection under the conditionof enteral nutrition support; measuring at the same time each nutritionalindicators and the change of absorptive function of the remainingintestine in patient after total small intestinal resection. Withcontents from both experimentsand clinical works, investigate into theadaptation situation of the remaining colon in total small intestineresected patient and the possibility of decreasing parenteral nutrition.Method: SD rats (30) randomly divided info 3 groups, short bowel group:made to ultra-short intestine rats group of 80-85% of intestine resected(10 rats), sham operated group: falsely operated group (10 rats), withintestinal resction done with anastomosis thereafter, control group:control group with operation not given (10 rats), pepti-2000 given toshort bowel group and sham operated group postoperatively for enteraltherapy, control group fed with same method and nutrition solution,observe the morphology of the colon (wall thickness, rugae height,mucosal thickness, rugae surface area and microscopic structure of themucosal absorptive epidermal cells), give closed continual circulatoryperfusion to the colons with vessel endings using D-xylose solution 21days after operation, and measure the colons' situation of water andcarbohydrate absorption. On the other hand, give short bowel syndromepatient general nutritional support and enteral rehabilitative therapyafter total small intestine resection and observe each nutritional indicators and the change of absorptive function for carbohydrate of theremaining colon.Results:1. short bowel group rats' colon 21 days after operation has obviousdifference from control group rats in adaptation morphological dysplasia.There is obvious increase in colonic wall thickness in short bowel groupfrom that in sham operated group and control group (677±18μm vs642±9μm,677±18μm vs637±7μm), P＜0.01. The difference between that in shamoperated group and control group has no statistical significance P＞0.05.There is obvious increase in colonic mucosal thickness in group shortbowel group from that in sham operated group and control group (388±13μm vs352±14μm, 388±13μm vs346±12μm), P＜0.01. The differencebetween that in sham operated group and control group has no statisticalsignificance P＞0.05. There is obvious increase in colonic rugae heightin group short bowel group from that in sham operated group and controlgroup (288±18μm vs261±15μm, 288±18μm vs254±6μm, ), P＜0.01. Thedifference between that in sham operated group and control group has nostatistical significance, P＞0.05. There is obvious increase in colonicrugae surface area in group short bowel group from that in sham operatedgroup and control group (14215±836μm~2vs11753±863μm~2, 14215±836μm~2vs11089±805μm~2), P＜0.01. The difference between that in shamoperated group and control group has no statistical significance, P＞0.05.2. Water absorption: after closed continual circulatory perfusion for 3hours, colonic absorptive function to water of group short bowel grouprats has obvious increase from that of sham operated group and controlgroup (2.67±0.09mlvs1.33±0.06ml, 2.67±0.09mlvs1.27±0.08ml), thedifference has obvious significance, (p＜0.01). The difference betweenthat of sham operated group and control group has no statisticalsignificance, P＞0.05. 3. D-xylose absorption: after closed continual circulatory perfusion for3 hours, absorptive rate to xylose of group short bowel group rats in thefirst and the second hour has increase from that of sham operated groupand control group, but there is statistical difference (7.54±0.37%vs6.08±0.18%, 7.54±0.37%vs6.05±0.14%; 11.24±0.53%vs8.07±0.13%, 11.24±0.53%vs8.03±0.10%), P＞0.05. That in the third hour of group short bowelgroup has obvious increase (18.21±0.69%vs9.50±0.28%, 18.21±0.69%vs9.38±0.42%), P＜0.01.4. Scanning electroscopic observation: small intestine mucosal surfacevilla of sham operated group and control group is obviously shortenedcompared to that of short bowel group, the number is also decreased, withwider inter-villa gaps. short bowel group villa have increase in density,are circular on the tip, are closely stick to each other and theinter-villa gaps are narrow. These show that short bowel group rats havesmall intestine with mucosal absorptive function greater than thatcontrol group rats with the same surface area.5. In patient of short bowel syndrome after general clinical nutritionalsupport and enteral rehabilitative therapy, comparing each nutritionalindicators before and after, obvious increases are found in areas of thepatient's weight, haemoglobin, level of plasma protein, totallymphocytic count, comparing to the previous test, absorptive functionto amino acid and D-xylose has increased, but there is still differenceof the two from normal people. The patient's dependence on parenteralnutrition is gradually decreased.Conclusion: Obvious morphological hyperplasia has occurred in the rats'colon under the condition of total small intestine resection, early properenteral nutrition not only can give ultra-short bowel rats sufficientnutritional support, but can also enhance morphological and functionaladaptation of the colon. Patients after total small intestine resection under general clinical nutritional support, especially enteral supportand enteral rehabilitative therapy, can gradually decrease the dependenceon parenteral nutrition.