術后腸梗阻的發生機制研究進展_《中國普外基礎與臨床雜志》

作者：

王李 , 童衛東

第三軍醫大學大坪醫院野戰外科研究所普通外科（重慶400042）;

關鍵詞：

術后腸梗阻神經反射炎癥反應藥物作用胃腸道動力

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的總結術后腸梗阻的發生機制的研究進展，闡述術后腸梗阻的發生機制對臨床診斷、治療及預防的重要意義。方法分析總結近年來有關術后腸梗阻發生機制的文獻報道。結果術后腸梗阻的發生與術后神經反射抑制、炎癥反應、藥物作用等多種因素有關，它是多種機制共同相互調節的結果。結論術后腸梗阻的胃腸道動力主要由神經反射、炎癥反應及藥物相互作用三種機制共同調節，三者在不同的時間段所起的作用不同，但又相互作用構成一個整體，其中炎癥反應對術后腸梗阻的持續起著關鍵性作用。

引用本文： 王李,童衛東. 術后腸梗阻的發生機制研究進展. 中國普外基礎與臨床雜志, 2011, 18(10): 1114-1117. doi: 復制

1.	Carroll J, Alavi K. Pathogenesis and management of postoperative ileus [J]. Clin Colon Rectal Surg, 2009, 22(1): 4750.
2.	Boeckxstaens GE, de Jonge WJ. Neuroimmune mechanisms in postoperative ileus [J]. Gut, 2009, 58(9): 13001311.
3.	Mueller MH, Karpitschka M, Xue B, et al. Intestinal afferent nerve sensitivity is increased during the initial development of postoperative ileus in mice [J]. J Gastrointest Surg, 2009, 13(3): 423431.
4.	Boeckxstaens GE, Hirsch DP, Kodde A, et al. Activation of an adrenergic and vagallymediated NANC pathway in surgeryinduced fundic relaxation in the rat [J]. Neurogastroenterol Motil, 1999, 11(6): 467474.
5.	Korolkiewicz RP, SeinAnand J, Ruczyński J, et al. The role and interactions of nitric oxide (no), carbon monoxide (CO), and prostanoids in the pathogenesis of postoperative ileus in rats [J]. J Gastrointest Surg, 2004, 8(3): 346357.
6.	Boeckxstaens GE, Hollmann M, Heisterkamp SH, et al. Evidence for VIP(1)/pacap receptors in the afferent pathway mediating surgeryinduced fundic relaxation in the rat [J]. Br J Pharmacol, 2000, 131(4): 705710.
7.	Gao Z, Müller MH, Karpitschka M, et al. Role of the vagus nerve on the development of postoperative ileus [J]. Langenbecks Arch Surg, 2010, 395(4): 407411.
8.	Doherty TJ. Postoperative ileus: pathogenesis and treatment [J]. Vet Clin North Am Equine Pract, 2009, 25(2): 351362.
9.	Kalff JC, Buchholz BM, Eskandari MK, et al. Biphasic response to gut manipulation and temporal correlation of cellular infiltrates and muscle dysfunction in rat [J]. Surgery, 1999, 126(3): 498509.
10.	Kalff JC, Schraut WH, Simmons RL, et al. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus [J]. Ann Surg, 1998, 228(5): 652663.
11.	Kalff JC, Carlos TM, Schraut WH, et al. Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus [J]. Gastroenterology, 1999, 117(2): 378387.
12.	de Jonge WJ, van den Wijngaard RM, The FO, et al. Postoperative ileus is maintained by intestinal immune infiltrates that activate inhibitory neural pathways in mice [J]. Gastroenterology, 2003, 125(4): 11371147.
13.	The FO, de Jonge WJ, Bennink RJ, et al. The ICAM1 antisense oligonucleotide ISIS3082 prevents the development of postoperative ileus in mice [J]. Br J Pharmacol, 2005, 146(2): 252258.
14.	The FO, Bennink RJ, Ankum WM, et al. Intestinal handlinginduced mast cell activation and inflammation in human postoperative ileus [J]. Gut, 2008, 57(1): 3340.
15.	de Jonge WJ, The FO, van der Coelen D, et al. Mast cell degranulation during abdominal surgery initiates postoperative ileus in mice [J]. Gastroenterology, 2004, 127(2): 535545.
16.	Schwarz NT, BeerStolz D, Simmons RL, et al. Pathogenesis of paralytic ileus:intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis [J]. Ann Surg, 2002, 235(1): 3140.
17.	Wehner S, Behrendt FF, Lyutenski BN, et al. Inhibition of macrophage function prevents intestinal inflammation and postoperative ileus in rodents [J]. Gut, 2007, 56(2): 176185.
18.	Bauer AJ. Mentation on the immunological modulation of gastrointestinal motility [J]. Neurogastroenterol Motil, 2008, 20 Suppl 1: 8190.
19.	Türler A, Schnurr C, Nakao A, et al. Endogenous endotoxin participates in causing a panenteric inflammatory ileus after colonic surgery [J]. Ann Surg, 2007, 245(5): 734744.
20.	Ohama T, Hori M, Ozaki H. Mechanism of abnormal intestinal motility in inflammatory bowel disease: how smooth muscle contraction is reduced？ [J]. J Smooth Muscle Res, 2007, 43(2): 4354.
21.	Kalff JC, Schraut WH, Billiar TR, et al. Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents [J]. Gastroenterology, 2000, 118(2): 316327.
22.	Kreiss C, Birder LA, Kiss S, et al. Cox2 dependent inflammation increases spinal Fos expression during rodent postoperative ileus [J]. Gut, 2003, 52(4): 527534.
23.	Korolkiewicz R, SeinAnand J. Cox2 inhibitors and postoperative ileus [J]. Colorectal Dis, 2007, 9(9): 856857.
24.	Mueller MH, Glatzle J, Kampitoglou D, et al. Differential sensitization of afferent neuronal pathways during postoperative ileus in the mouse jejunum [J]. Ann Surg, 2008, 247(5): 791802.
25.	Johnson MD, Walsh RM. Current therapies to shorten postoperative ileus [J]. Cleve Clin J Med, 2009, 76(11): 641648.
26.	Viscusi ER, Gan TJ, Leslie JB, et al. Peripherally acting muopioid receptor antagonists and postoperative ileus: mechanisms of action and clinical applicability [J]. Anesth Analg, 2009, 108(6): 18111822.
27.	Iyer S, Saunders WB, Stemkowski S. Economic burden of postoperative ileus associated with colectomy in the United States [J]. J Manag Care Pharm, 2009, 15(6): 485494.
28.	Kraft M, Maclaren R, Du W, et al. Alvimopan (entereg) for the management of postoperative ileus in patients undergoing bowel resection [J]. P T, 2010, 35(1): 4449.
29.	Becker G, Blum HE. Novel opioid antagonists for opioidinduced bowel dysfunction and postoperative ileus [J]. Lancet, 2009, 373(9670): 11981206.
30.	Erowele GI. Alvimopan (entereg), a peripherally acting muopioid receptor antagonist for postoperative ileus [J]. P T, 2008, 33(10): 574583.
31.	Karuppiah S, Farrah R. Alvimopan (entereg) for the treatment of postoperative ileus [J]. Am Fam Physician, 2011, 83(8): 978979.
32.	Delaney CP, Weese JL, Hyman NH, et al. Phase Ⅲ trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery [J]. Dis Colon Rectum, 2005, 48(6): 11141125.
33.	Herzog TJ, Coleman RL, Guerrieri JP Jr, et al. A doubleblind, randomized, placebocontrolled phase III study of the safety of alvimopan in patients who undergo simple total abdominal hysterectomy [J]. Am J Obstet Gynecol, 2006, 195(2): 445453.
34.	Asantila R, Eklund P, Rosenberg PH. Continuous epidural infusion of bupivacaine and morphine for postoperative analgesia after hysterectomy [J]. Acta Anaesthesiol Scand， 1991， 35(6): 513517.
35.	Jrgensen H, Fomsgaard JS, Dirks J, et al. Effect of peri and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy [J]. Br J Anaesth， 2001， 87(4): 577583.
36.	Liu SS, Carpenter RL, Mackey DC, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery [J]. Anesthesiology, 1995, 83(4): 757765.
37.	Holte K, Kehlet H. Epidural anaesthesia and analgesia-effects on surgical stress responses and implications for postoperative nutrition [J]. Clin Nutr, 2002, 21(3): 199206.

1. Carroll J, Alavi K. Pathogenesis and management of postoperative ileus [J]. Clin Colon Rectal Surg, 2009, 22(1): 4750.
2. Boeckxstaens GE, de Jonge WJ. Neuroimmune mechanisms in postoperative ileus [J]. Gut, 2009, 58(9): 13001311.
3. Mueller MH, Karpitschka M, Xue B, et al. Intestinal afferent nerve sensitivity is increased during the initial development of postoperative ileus in mice [J]. J Gastrointest Surg, 2009, 13(3): 423431.
4. Boeckxstaens GE, Hirsch DP, Kodde A, et al. Activation of an adrenergic and vagallymediated NANC pathway in surgeryinduced fundic relaxation in the rat [J]. Neurogastroenterol Motil, 1999, 11(6): 467474.
5. Korolkiewicz RP, SeinAnand J, Ruczyński J, et al. The role and interactions of nitric oxide (no), carbon monoxide (CO), and prostanoids in the pathogenesis of postoperative ileus in rats [J]. J Gastrointest Surg, 2004, 8(3): 346357.
6. Boeckxstaens GE, Hollmann M, Heisterkamp SH, et al. Evidence for VIP(1)/pacap receptors in the afferent pathway mediating surgeryinduced fundic relaxation in the rat [J]. Br J Pharmacol, 2000, 131(4): 705710.
7. Gao Z, Müller MH, Karpitschka M, et al. Role of the vagus nerve on the development of postoperative ileus [J]. Langenbecks Arch Surg, 2010, 395(4): 407411.
8. Doherty TJ. Postoperative ileus: pathogenesis and treatment [J]. Vet Clin North Am Equine Pract, 2009, 25(2): 351362.
9. Kalff JC, Buchholz BM, Eskandari MK, et al. Biphasic response to gut manipulation and temporal correlation of cellular infiltrates and muscle dysfunction in rat [J]. Surgery, 1999, 126(3): 498509.
10. Kalff JC, Schraut WH, Simmons RL, et al. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus [J]. Ann Surg, 1998, 228(5): 652663.
11. Kalff JC, Carlos TM, Schraut WH, et al. Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus [J]. Gastroenterology, 1999, 117(2): 378387.
12. de Jonge WJ, van den Wijngaard RM, The FO, et al. Postoperative ileus is maintained by intestinal immune infiltrates that activate inhibitory neural pathways in mice [J]. Gastroenterology, 2003, 125(4): 11371147.
13. The FO, de Jonge WJ, Bennink RJ, et al. The ICAM1 antisense oligonucleotide ISIS3082 prevents the development of postoperative ileus in mice [J]. Br J Pharmacol, 2005, 146(2): 252258.
14. The FO, Bennink RJ, Ankum WM, et al. Intestinal handlinginduced mast cell activation and inflammation in human postoperative ileus [J]. Gut, 2008, 57(1): 3340.
15. de Jonge WJ, The FO, van der Coelen D, et al. Mast cell degranulation during abdominal surgery initiates postoperative ileus in mice [J]. Gastroenterology, 2004, 127(2): 535545.
16. Schwarz NT, BeerStolz D, Simmons RL, et al. Pathogenesis of paralytic ileus:intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis [J]. Ann Surg, 2002, 235(1): 3140.
17. Wehner S, Behrendt FF, Lyutenski BN, et al. Inhibition of macrophage function prevents intestinal inflammation and postoperative ileus in rodents [J]. Gut, 2007, 56(2): 176185.
18. Bauer AJ. Mentation on the immunological modulation of gastrointestinal motility [J]. Neurogastroenterol Motil, 2008, 20 Suppl 1: 8190.
19. Türler A, Schnurr C, Nakao A, et al. Endogenous endotoxin participates in causing a panenteric inflammatory ileus after colonic surgery [J]. Ann Surg, 2007, 245(5): 734744.
20. Ohama T, Hori M, Ozaki H. Mechanism of abnormal intestinal motility in inflammatory bowel disease: how smooth muscle contraction is reduced？ [J]. J Smooth Muscle Res, 2007, 43(2): 4354.
21. Kalff JC, Schraut WH, Billiar TR, et al. Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents [J]. Gastroenterology, 2000, 118(2): 316327.
22. Kreiss C, Birder LA, Kiss S, et al. Cox2 dependent inflammation increases spinal Fos expression during rodent postoperative ileus [J]. Gut, 2003, 52(4): 527534.
23. Korolkiewicz R, SeinAnand J. Cox2 inhibitors and postoperative ileus [J]. Colorectal Dis, 2007, 9(9): 856857.
24. Mueller MH, Glatzle J, Kampitoglou D, et al. Differential sensitization of afferent neuronal pathways during postoperative ileus in the mouse jejunum [J]. Ann Surg, 2008, 247(5): 791802.
25. Johnson MD, Walsh RM. Current therapies to shorten postoperative ileus [J]. Cleve Clin J Med, 2009, 76(11): 641648.
26. Viscusi ER, Gan TJ, Leslie JB, et al. Peripherally acting muopioid receptor antagonists and postoperative ileus: mechanisms of action and clinical applicability [J]. Anesth Analg, 2009, 108(6): 18111822.
27. Iyer S, Saunders WB, Stemkowski S. Economic burden of postoperative ileus associated with colectomy in the United States [J]. J Manag Care Pharm, 2009, 15(6): 485494.
28. Kraft M, Maclaren R, Du W, et al. Alvimopan (entereg) for the management of postoperative ileus in patients undergoing bowel resection [J]. P T, 2010, 35(1): 4449.
29. Becker G, Blum HE. Novel opioid antagonists for opioidinduced bowel dysfunction and postoperative ileus [J]. Lancet, 2009, 373(9670): 11981206.
30. Erowele GI. Alvimopan (entereg), a peripherally acting muopioid receptor antagonist for postoperative ileus [J]. P T, 2008, 33(10): 574583.
31. Karuppiah S, Farrah R. Alvimopan (entereg) for the treatment of postoperative ileus [J]. Am Fam Physician, 2011, 83(8): 978979.
32. Delaney CP, Weese JL, Hyman NH, et al. Phase Ⅲ trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery [J]. Dis Colon Rectum, 2005, 48(6): 11141125.
33. Herzog TJ, Coleman RL, Guerrieri JP Jr, et al. A doubleblind, randomized, placebocontrolled phase III study of the safety of alvimopan in patients who undergo simple total abdominal hysterectomy [J]. Am J Obstet Gynecol, 2006, 195(2): 445453.
34. Asantila R, Eklund P, Rosenberg PH. Continuous epidural infusion of bupivacaine and morphine for postoperative analgesia after hysterectomy [J]. Acta Anaesthesiol Scand， 1991， 35(6): 513517.
35. Jrgensen H, Fomsgaard JS, Dirks J, et al. Effect of peri and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy [J]. Br J Anaesth， 2001， 87(4): 577583.
36. Liu SS, Carpenter RL, Mackey DC, et al. Effects of perioperative analgesic technique on rate of recovery after colon surgery [J]. Anesthesiology, 1995, 83(4): 757765.
37. Holte K, Kehlet H. Epidural anaesthesia and analgesia-effects on surgical stress responses and implications for postoperative nutrition [J]. Clin Nutr, 2002, 21(3): 199206.

《中國普外基礎與臨床雜志》

術后腸梗阻的發生機制研究進展

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國普外基礎與臨床雜志》

術后腸梗阻的發生機制研究進展

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料