| Adhesive Intestinal Obstruction (AIO) is a chronic, unpredictable problem after abdominal surgery, which is becoming gastrointestinal surgery research hot spot. Its’incidence is on the rise along with the increasing of the abdominal surgery.Although many drugs have a certain role on the abdominal adhesions, there is not a recognized and effective clinical method to prevent that. Therefore, actively exploring an effective prevention of the AIO is one of the important subject of study in the field of medicine today. This research is working on the following three areas from traditional Chinese medicine enema:First:Literature StudyBy reviewing the relationship between Chinese and Western medicine’s each theory about the mechanism of adhesive intestinal obstruction, the protection of the intestinal barrier, we can lay a solid theoretical foundation and an important clinical significance on Chinese medicine enema.Second:Experimental StudyObjective:To study the protective mechanism of traditional Chinese medicine enema on the intestinal barrier of adhesive intestinal obstruction from the perspective of animal experiments.Method:50Sprague Dawley(SD)rats were randomly divided into five groups: normal group, sham group, saline group, high dose group, low dose group. Normal group, sham group, saline group with0.9%saline enema; high dose group with10ml/kg Tongfu Xiere enema and low dose group5ml/kg. In the morning of one day after modeling to prepare retention enema, the enema temperature38℃, take on the8th of pediatric catheter for anal enema after emptying the faeces as much as possible, anal insertion depth about3-5cm, and slowly inject the enema, and the catheter pulled out after5min to minimize the leakage of the enema. By intraperitoneal injection of10%chloral hydrat for anesthesia, rats were drawn blood first, given intestinal adhesion Phyllips classification, and then taken the appropriate specimens such as serum ET, serum IL-4, sIgA in intestinal contents, intestinal NO and NOS, intestinal protein content detection and ileal tissue specimens sent to the relevant department.Results:1. The number of intraperitoneal adhesions in normal saline group was maximum with close sticking, part of the proximal bowel dilatation, the distal bowel coarctation of adhesive intestinal obstruction changes and enema;the peritoneal adhesions in the high dose group was less adhesive as film, easy to separate, while adhesions in the low dose group increased with bleeding after the separation of serous surface; there were not significant adhesions in the abdominal cavity in sham group and normal group.2. After treatment for two weeks, endothelin (ET) level in high dose group and low dose group was significantly lower than saline group(P<0.05). At the same time endothelin level in normal group and shame group was also lower than normal saline group, with statistical significance (P<0.05). Compared with the shame group, ET in saline group was significantly higher (P<0.01),while ET in high dose and low dose group declined, with statistical significance (P<0.05).3. Two weeks treatment of saline group was less effective, with lower IL-4level. IL-4level was significantly higher than normal saline enema in high dose group (P<0.01)and in the low dose group(P<0.05);Compared with the shame group, IL-4level in high dose group was also significantly higher (P<0.01)and in low dose group higher (P<0.05);IL-4level in saline group was lower than shame group with statistical significance (P<0.05).4. After two weeks treatment, SIgA concentration in saline group was minimum, while it was significantly higher of SIgA contained concentrations than saline group in high dose group(P<0.01), low dose group, normal group and shame group (P<0.05). Compared with shame group, SIgA concentration wsa significantly higher in high dose group (P<0.01) and in low dose group (P<0.05), whi le lower in saline group (P<0.01).5. Compared with saline group, the content of NO and NOS in the other four groups was lower (P<0.01); And there was no significant difference in normal group, high dose group and low dose group comparing with shame group.6. Compared with saline group, intestinal mucosal protein content was significantly higher in normal, high dose group (P<0.01)and in shame, low dose group(P<0.05). And there was still no significant difference in normal group, high dose group and low dose group comparing with shame group.7. Pathological results:Lamina propria in saline group had a large number of chronic inflammatory cell infiltration, but there was a slightly larger range than that in shame group. Compared with saline group, the number of chronic inflammatory cell in lamina propria layer declined significantly in high dose group and reduced slightly in low dose group. Intestinal villus of normal full, There was no inflammatory cell infiltration of lamina propria layer in normal group, but there was a portion of the lamina propria in shame group. Edema and inflammatory cell infiltration were not been found in submucosa in all groups.Conclusion:In this study, rats of adhesive intestinal obstruction model were given Tongfu Xiere and saline enema. In the Tongfu Xiere enema groups, intraperitoneal adhesions significantly decreased compared with the saline group after two weeks of treatment, while ET level and intestinal tissue NO and NOS levels in the serum were significantly lower, but serum IL-4, SIgA content of intestinal issue and mucosa protein content were significantly higher than the saline group. Then our research showed that Tongfu Xiere enema could significantly reduce intestinal mucosal injury, reducing the inflammatory reaction and improving the intestinal mucosa ultrastructure, and enhancing intestinal barrier function, ultimately proving its systemic protection mechanisms of intestinal barrier function of adhesive intestinal obstruction.Third:Clinical curative effect observation60adhesive intestinal obstruction cases were collected in the Second Surgery Department from March,2010to March,2012in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.The results showed that the Tongfu Xiere enema had a good effect in the treatment of adhesive intestinal obstruction, while it could effectively promote the recovery of gastrointestinal function, alleviate intestinal inflammation, shorten the time of anal exhaust defecation, etc. Now two typical cases had been selected to report. |
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