目的 探讨大鼠结肠电切术后创面自然愈合过程以及黏膜切除、全层切开两种手术方式愈合情况的差异.方法 将24只SD大鼠随机分为手术组12只(每只大鼠据两处手术创面将标本归入黏膜切除组和全层切开组)、对照组(无特殊处理)12只,分别于术后第4、7、12天取结肠溃疡局部组织,HE染色后观察愈合情况,免疫组化法测定Ⅲ型胶原、Ⅳ型胶原、碱性成纤维细胞生长因子(b-FGF)及转化生长因子β1(TGF-β1)的表达.结果 ①组织愈合情况:与对照组结肠标本相比,黏膜切除组及全层切开组标本均有不同程度的纤维结缔组织增生、炎性细胞浸润,组织缺损处均有不同程度的纤维结缔组织填充.同一时间点黏膜切除组、全层切开组再生上皮成熟度差异无统计学意义(P均＞0.05),但黏膜切除组较早出现中级愈合改变(第4天)；术后第7天时,黏膜切除组填充程度明显优于全层切开组(P＜0.05).②组织生长因子及胶原表达:术后第4、7天,黏膜切除组Ⅲ型胶原、Ⅳ型胶原表达与全层切开组比较差异有统计学意义(P均＜0.05).肠壁损伤后,黏膜切除组、全层切开组内源性b-FGF及TGF-β1表达均升高,但两组同一时间点b-FGF、TGF-β1表达差异无统计学意义(P均＞0.05).结论 大鼠结肠电切术后黏膜切除组和全层切开组组织愈合过程基本相同,但全层切开组结缔组织的修复完善所需时间可能长于黏膜切除组.%Objective To investigate the natural healing process of rat colon after electrocision and its difference between two surgical approaches.Methods 24 SD rats were randomly divided into operation group(12 rats,samples of this group were divided into mucosa electrosurgical resection group and full-thickness incision group according to different surgical wounds of a rat) and control group(12 rats,untreated group).The local tissue of rat colon ulcer was obtained on the 4th,7th,12th day after operation in groups.The healing of ulcerated tissue was observed by HE staining.The expressions of collagen Ⅲ,collagen Ⅳ,b-FGF and TGF-β1 in the ulcerated tissues were determined by immunohistochemistry.Results ①Healing of ulcerated tissues:Compared with control group,the colonic samples of mucosa electrosurgical resection group and full-thickness incision group were both infiltrated with inflammatory cells and hyperplasia fibrous connective tissue,and the defect of tissue was both filled with various fibrous connective tissue.At the same time point,differences in the degree of maturation of the regenerated epithelium tissue in the both group were not statistically significant (all P ＞ 0.5).But,the change of intermediate healing was earlier in mucosa electrosurgical resection group than that in full-thickness incision group (on the 4th day after the operation).The degree of filling of fibrous connective tissue in mucosa electrosurgical resection group was significantly better than that in full-thickness incision group on the 7th day after the operation (P ＜0.05).②Expression of growth factors and collagen:On the 4th and 7th day after the operation,there were statistical differences in the expression of collagen Ⅱ and collagen Ⅳ between mucosa electrosurgical resection group and full-thickness incision group(all P ＜ 0.05).The expressions of endogenous b-FGF and TGF-β increased in both groups after the injury of colonic wall,but,there were no statistical differences in these two groups at the same time point(all P ＞ 0.05).Conclusions The healing processes of rat colon in mucosa electrosurgical resection group and full-thickness incision group are not significantly different.But,the healing process of fibrous connective tissue consumes more time in full-thickness incision group comparing with mucosa electrosurgical resection group.
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