CAJ | 학술논문

目的探讨肠液回输对唇状瘘患者肠黏膜屏障功能和机体营养状态的影响。方法选取1995年7月至2008年5月我院收治的16例唇状瘘患者，所选病例均符合以下条件：肠道功能基本恢复、腹腔感染基本控制、完全依赖肠内营养、肠液回输肠襻的长度＞ 50 cm。分别于实施肠液回输当天、第7和14天，在肠镜引导下距小肠远端瘘口25～30 cm处取肠黏膜，行HE染色后统计肠上皮内淋巴细胞(IIELS)百分数、免疫组织化学染色后分析增殖细胞核抗原(PCNA)阳性细胞百分数。同时测定血清蛋白水平。结果实施肠液回输第14天瘘口远端小肠黏膜内IIELS百分数为19.06％±4.81％，显著高于肠液回输当天的12.81％±2.95％ (P=0.000)，PCNA阳性细胞百分数为12.13％±4.33％，显著高于肠液回输当天的6.44％±2.34％ (P=0.000)。肠液回输第14天血清纤维连接蛋白水平由( 152.80±16.50)上升至(227.05±45.36) mg/L (P=0.000)、转铁蛋白水平由(2.16±0.52)上升至（2.62±0.41）g/L (P =0.017)。结论实施肠液回输对于肠外瘘患者的肠黏膜具有保护作用。
목적 탐토장액회수대진상루환자장점막병장공능화궤체영양상태적영향。방법 선취1995년7월지2008년5월아원수치적16례진상루환자，소선병례균부합이하조건：장도공능기본회복、복강감염기본공제、완전의뢰장내영양、장액회수장반적장도＞ 50 cm。분별우실시장액회수당천、제7화14천，재장경인도하거소장원단루구25～30 cm처취장점막，행HE염색후통계장상피내림파세포(IIELS)백분수、면역조직화학염색후분석증식세포핵항원(PCNA)양성세포백분수。동시측정혈청단백수평。결과 실시장액회수제14천루구원단소장점막내IIELS백분수위19.06％±4.81％，현저고우장액회수당천적12.81％±2.95％ (P=0.000)，PCNA양성세포백분수위12.13％±4.33％，현저고우장액회수당천적6.44％±2.34％ (P=0.000)。장액회수제14천혈청섬유련접단백수평유( 152.80±16.50)상승지(227.05±45.36) mg/L (P=0.000)、전철단백수평유(2.16±0.52)상승지（2.62±0.41）g/L (P =0.017)。결론 실시장액회수대우장외루환자적장점막구유보호작용。
Objective To observe the effect of succus entericus reinfusion with continuous enteral nutrition on the barrier function of intestinal mucosa and nutritional status in patients with stomal type fistulas. Methods Sixteen patients with stomal type fistula from July 1995 to May 2008 were enrolled in the study. A]l patients met the following conditions: gut function returned normal; abdominal infection was controlled; total enteral nutrition was provided ; and the length of small intestine for succus entericus reinfusion was more than 50 cm. Intestinal mucosa was taken at 25 to 30 cm away from stoma of fistula by endoscope 0, 7, and 14 days after reinfusior. Hematoxylineosin staining was performed to count the number of intestinal intraepithelial lymphocytes (IIELS). In addition,proliferating cell nuclear antigen (PCNA) was measured with immunohistochemical staining. Serum protein levels were determined by immunonephelometry. Results The percentage of IIELS in intestinal mucosa ( 19.06％ ±4.81％ vs. 12.81％ ±2.95％, P=0.000) and the percentage of PCNA positive cells ( 12.13％ ±4.33％ vs.6.44％ ± 2.34％, P =0.000) 14 days after succus entericus reinfusion were significantly higher than those on the day of reinfusion. Serum fibronectin level increased from ( 152.80 ± 16.50 ) to ( 227.05 ± 45.36 ) mg/L ( P =0.000), and transferring protein level increased from ( 2.16 ± 0.52 ) to ( 2.62 ± 0.41 ) g/L ( P =0.017 ) 14days after succus entericus reinfusion. Conclusion Succus entericus reinfusion is effective in protecting the intestinal mucosa in patients with stomal type fistulas.