ABSTRACT
Objective To explore the influence between perioperative nutritional support and outcome of refractory constipation patients complicated with megacolon.Methods Seventy-three patients with refractory constipation complicated with megacolon receiving surgical interventions were enrolled,both by gastrointestinal decompression and total parenteral nutrition support treatment.Thirty-seven cases who could not recover intestinal tract unobstructed,did not receive enteral nutrition support treatment and surgery as control group; 36 cases of patients with intestinal recovery unobstructed,after 2 weeks of total enteral nutrition support undergoing elective surgery as observation group.The nutrition indicators,surgery and postoperative complications between two groups were compared.Results The operation time and intraoperative blood loss compared between two groups had no significant difference (P ＞0.05).The operation method between two groups was statistically significants (P ＜ 0.05).The incidence of anastomotic bleeding,anastomotic fistula and pneumonia in observation group were lower than those in control group [2.8％ (1/36) vs.21.6％ (8/37),0 vs.13.5％ (5/37) and 0 vs.13.5％ (5/37)],there were significant differences (P ＜ 0.05).The hospitalization time,incidence of incision infection,urinary retention,intestinal obstruction between two groups had no significant difference (P ＞ 0.05).The postoperative hospital stay in observation group was shorter than that in control group [(12 ± 3) d vs.(25 ± 6) d],there was significant difference (P ＜ 0.05).The index comparison on admission similar between two groups had no statistical significance (P ＞0.05).The preoperative fat weight,fat mass and serum albumin,transferrin and prealbumin in observation group were higher than those in control group [(41.9 ± 7.6) kg vs.(38.7 ± 3.0) kg,(13.2 ± 4.0) kg vs.(7.8 ± 2.7) kg,(37.9 ± 2.6) g/L vs.(31.3 ± 2.5) g/L,(2.9 ± 0.6) μ g/L vs.(2.0 ± 0.6) μ g/L,(243.7 ± 25.2) mg/L vs.(141.2 ± 11.9) mg/L],there were significant differences (P ＜ 0.05).After 1 month,the weight,fat weight,protein quality,fluid in cells and extracellular fluid,body mass index,albumin,transferrin in observation group were better than those in control group [(55.1 ± 6.4) kg vs.(50.9±4.7) kg,(42.9 ± 3.2) kgvs.(39.1 ± 1.3) kg,(12.2 ± 1.4) kg vs.(9.7 ± 3.2) kg,(23.7 ± 5.0) Lvs.(18.8 ± 5.5) L,(10.9 ± 4.5) L vs.(7.7 ± 0.8) L,(22.3 ± 1.9) kg/m2 vs.(17.5 ± 3.6) kg/m2,(41.9 ± 4.7) g/L vs.(33.1 ± 2.9) g/L and (3.5 ± 0.7) μg/L vs.(2.7 ± 0.5) μg/L],there were significant differences (P ＜0.05).Conclusion Refractory constipation complicated with megacolon requires surgical intervention,should as far as possible to restore the intestinal function preoperatively,enteral nutrition support treatment,can significantly reduce the incidence of perioperative complications.
ABSTRACT
BACKGROUND: Hepatic oval cells (HOCs) possess the potential of self-renewal, replication, and clone, proliferation and differentiation into mature hepatocytes under a certain condition. HOCs can be used as biomaterial for constructing biological artificial liver in vitro, employed for in vivo transplantation, as well as for tissue engineering as seed cells. HOCs can be widely used for improving clinical treatment of liver diseases. OBJECTIVE: To establish adult Wistar rat models of HOC proliferation, to perform/n vitro isolation and culture of HOCs, and to study the possibility of induction and differentiation of HOCs into hepatucytes. DESIGN: Observational study. SETTING: Institute of Gastroenterology, Nanfang Hospital, Southern Medical University. MATERIALS: Experiments were performed at the Laboratory of Institute of Gastroenterology of Nanfang Hospital from December 2003 to February 2006. Thirty-six healthy male Wistar rats aged 3-4 months (150-200 g) were provided by Experimental Animal Center of Southern Medical University. METHODS: Male Wistar rats were orally fed with ethionine received two-thirds partial hepatectomy (2/3 PH). HOCs were harvested and purified by two-steps perfusion and Percoll density gradient centrifugation, and then cultured in vitro and induced with hepatocyte growth factor (HGF), oncostatin M (OSM) and fibroblast growth factor-4 (FGF4). MAIN OUTCOME MEASURES: Identification and differentiation of HOCs. RESULTS: The concentration of HOCs was about 1.34×108 L-1 in each rat model after in vitro isolation. These cells were round, oval or polygon, about 1/6 1/3 the size of normal hepatocytes. The nucleus-cytoplasm ratio was relatively large. After 2 weeks, clone-like proliferation of HOCs could be observed. Laser scanning confocal microscopy indicated positive expression of stem cells markers Thy-1 and C-kit in cytoplasm and membrane of HOCs. Immunocytochemistry demonstrated positive stem cells marker alpha fetoprotein (AFP) in cytoplasm of HOCs. HOCs can stably passage and its shape gradually changed after inducing with HGF, OSM and FGF4. HOC volume became larger and HOCs lost their ability of sticking to the wall of culture flask. Apparent positive stain of cytoplasm albumin (Alb) was detected 14 days after induction, and the positive ratio increased along with the extension of inducing duration. Results of cytochemistry indicated a brown or black deposit after glucose-6-phosphotase (G-6-P) staining and red particles after periodic acid-Schiff (PAS) staining. CONCLUSION: Adult Wistar rat models of HOC proliferation are replicated by ethionine feeding combined with 2/3 PH. HOCs can be obtained through collagenase perfusion and Percoll density gradient centrifugation. Rat HOCs can be passaged and cultured in vitro. Under a certain condition, HOCs can be induced and differentiated into hepatocytes.