장폐쇄에서 나타나는 장점막 손상의 진단에서 내독소의 유용성 (The Usefulness of Endotoxin for Detection of Mucosal Injury in Intestinal Obstruction)

서지정보

· 발행기관 : 대한외과학회
· 수록지 정보 : Annals of Surgical Treatment and Research / 74권 / 2호 / 121 ~ 125페이지
· 저자명 : 이정은, 염차경, 박재정, 한기환, 허정원, 성순희, 정구용

초록

Purpose: The treatment outcome of an intestinal obstruction depends on the early recognition and emergent operation of a strangulated intestinal obstruction. Endotoxin is a lipopolysaccharide component of the cell wall of gram negative bacteria that normally exist in the intestinal lumen. When a strangulated obstruction occurs, the endotoxin passes transluminally into the peritoneal cavity and blood stream. A disruption of the mucosal barrier is an important putative cause in this pathogenesis. This study investigated the relationship between the endotoxin level and progress of an intestinal obstruction to a strangulated obstruction.
Methods: 25 adult male Sprague-Dawley rats (200∼250 g) were divided into 3 groups, the control group, simple obstruction group, and closed loop obstruction group. An intestinal obstruction was induced using a silk tie. Blood samples and obstructed bowel wall specimens were obtained at 24, 48 and 72 hours after surgery. The endotoxin and IL-6 levels were examined, and all specimens were reviewed by a pathologist for mucosal damage after H-E staining.
Results: In the obstruction groups, dilated bowel loops at the proximal end of the obstruction site was identified but there were no ischemic changes. The endotoxin and IL-6 levels were similar regardless of the obstruction types and times. There were no differences between the three groups
in the degree of mucosal damage. However, according to the endotoxin level, the groups with an endotoxin level ＜0.2 EU/ml showed mild mucosal damage. The severity of mucosal damage increased with increasing endotoxin level.
Conclusion: There is a positive relationship (r2=0.673, P-value=0.002) between the endotoxin level and mucosal damage. This suggests the possibility of using endotoxin as a predictive factor for the detection of mucosal injury in an intestinal obstruction. However, a larger scale will be needed to confirm the statistical significance. (J Korean Surg Soc 2008;74:121-125)

영어초록

Purpose: The treatment outcome of an intestinal obstruction depends on the early recognition and emergent operation of a strangulated intestinal obstruction. Endotoxin is a lipopolysaccharide component of the cell wall of gram negative bacteria that normally exist in the intestinal lumen. When a strangulated obstruction occurs, the endotoxin passes transluminally into the peritoneal cavity and blood stream. A disruption of the mucosal barrier is an important putative cause in this pathogenesis. This study investigated the relationship between the endotoxin level and progress of an intestinal obstruction to a strangulated obstruction.
Methods: 25 adult male Sprague-Dawley rats (200∼250 g) were divided into 3 groups, the control group, simple obstruction group, and closed loop obstruction group. An intestinal obstruction was induced using a silk tie. Blood samples and obstructed bowel wall specimens were obtained at 24, 48 and 72 hours after surgery. The endotoxin and IL-6 levels were examined, and all specimens were reviewed by a pathologist for mucosal damage after H-E staining.
Results: In the obstruction groups, dilated bowel loops at the proximal end of the obstruction site was identified but there were no ischemic changes. The endotoxin and IL-6 levels were similar regardless of the obstruction types and times. There were no differences between the three groups
in the degree of mucosal damage. However, according to the endotoxin level, the groups with an endotoxin level ＜0.2 EU/ml showed mild mucosal damage. The severity of mucosal damage increased with increasing endotoxin level.
Conclusion: There is a positive relationship (r2=0.673, P-value=0.002) between the endotoxin level and mucosal damage. This suggests the possibility of using endotoxin as a predictive factor for the detection of mucosal injury in an intestinal obstruction. However, a larger scale will be needed to confirm the statistical significance. (J Korean Surg Soc 2008;74:121-125)

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