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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 investigate the possibility of implanted intestinal ostomy in dynamic rectus abdominis and the effects of different electrical stimulation methods on the shape and function of sphincter of forming. Methods Ten Chinese mongrel dogs were randomly divided into three groups: control group, muscle stimulation group and intestinal cavity stimulation group. Before and after electrical stimulation, the basic pressure (resting pressure), the pressure under electrical stimulation, the lowest frequency of muscle spasm (fusion frequency) and the retention time of enema were measured respectively in the fistula. After electrical stimulation, the sphincter was taken for myosin ATPase staining, and the changes of type Ⅰ muscle fiber were evaluated. HE staining was used to understand the changes of the tissue structure. Results After the electrical stimulation training, the resting pressure in the intestine increased (P> 0.05). Under 5 V electrical stimulation, the pressure in the intestine reached 60 mmHg; the frequency of muscle fusion decreased (P <0.05). In the non-electrical stimulation and electrical stimulation conditions, the retention time of the enema in animals was longer (P <0.05), and the retention time of enemas in the animals of the same group was longer than that in the non-electrical stimulation conditions (P <0.05). The rectus abdominis muscle was stimulated by electrical stimulation, and the proportion of type Ⅰ muscle fibers increased. There was significant difference between group B and control (P <0.05). After electrical stimulation, HE staining showed myocyte atrophy and increased blood vessel composition. Necrosis of the muscles and surrounding intestinal wall structure. Conclusion After the rectus abdominis is formed, the pressure in the intestine can reach 60mmHg for controlling defecation under the condition of electrical stimulation. After direct muscle stimulation and intestine electrical stimulation training, muscle type Ⅰ fibers increased, the rectus abdominis muscle can have the function of the muscle and fistula intestinal wall structure without damage.