| Background Early postoperative inflammatory small bowel obstruction(EPISBO)is a type of intestinal obstruction that occurs within 1-2 weeks after abdominal surgery and is characterized by the coexistence of mechanical and dynamic derangement.The obstruction arises from thickening of the canal wall and narrowing of the intestinal lumen due to congestion and edema of the intestinal wall,accompanied by intestinal motility dysfunction.Because of the serious intestinal adhesions and inflammatory exudation,forced surgery to separate the adhesions causes serious complications such as intestinal tube injury,so the clinical treatment is mainly non-surgical.However,the recovery period for conservative treatment of western medicine alone is long,which brings serious burden to patients physically,mentally and economically.In recent years,traditional Chinese medicine enema therapy has played a great advantage in the non-surgical treatment of EPISBO,and has achieved satisfactory results.Objective To investigate the therapeutic effect and mechanism of action of TongfuJianpi soup on the Early postoperative inflammatory small bowel obstruction by observing the morphology changes of rat small intestine,HE stained sections and detecting the changes of tumor necrosis factor-α,interleukin-6,interleukin-10 and ICC expression,and to provide experimental basis for clinical application.Methods Fifty-four Wistar rats were randomly divided into blank group,anesthesia group,sham surgery group,model group,traditional Chinese medicine enema group and soapy water enema group according to random number list method,with nine rats in each group.The EPISBO models were generated by wiping the wall of rat’s small intestine.The administration began on the 1st day after the model was successfully prepared,and the dose of traditional Chinese medicine enema group was 8.46g/(kg·d);soapy water enema group was given to equal volumes of 0.2%soapy water enema once a day for a week.After the intervention,the rats were observed for general conditions and the morphological characteristics of the small intestine,and the level of intestinal adhesion were compared among the groups.The abdominal aorta blood and intestinal tissue were collected;the pathological changes of intestinal tissue were detected by hematoxylin eosin(HE)staining;the blood levels of TNF-α,IL-6 and IL-10 were detected by ELISA;and the expression of c-kit positive ICC was detected by immunofluorescence.Results 1.The general condition of rats:The experimental rats in the blank group showed no significant changes in food intake,body weight,defecation condition,mental and activity.The anesthesia group and sham-operated group had poor mental activity in the 24h postoperative period,and then could recover to normal level.Compared with the blank group,the rats in the model group were depressed,lacked activity,had dull fur,significantly reduced food intake,reduced defecation or even basically no defecation,and decreased body weight significantly.Compared with the model group,the rats in the traditional Chinese medicine enema group showed improvement in body weight loss,reduced food intake,reduced defecation,mental and activity after enema intervention;the rats in the soapy water enema group showed better results than the model group but worse than the traditional Chinese medicine enema group.2.Morphological changes of the rat small intestine:Rats in the blank group,anesthesia group and sham-operated group had normal intestinal morphology and had adequate blood supply.Rats in the model group,traditional Chinese medicine enema group and soapy water enema group showed intestinal adhesion,congestion and edema,dilatation of the intestinal tube above the obstruction and deflation of the intestinal tube below the obstruction,etc.However,the performance of the rats in the traditional Chinese medicine enema group was significantly reduced compared with the model group and soapy water enema group.3.Nair grade:No adhesions were found in the in the blank group,anesthesia group,and sham-operated group.Rats in the model group,traditional Chinese medicine enema group and soapy water enema group all have different degrees of adhesions.Compared with the model group and soapy water enema group,the incidence of small intestinal adhesions and the severity level of adhesions in traditional Chinese medicine enema group were significantly lower(P<0.05).4.Microhistopathological sections of rat small intestine were examined:The structure of the small intestinal mucosa was normal in the blank group,anesthesia group and sham-operated group,with no significant changes.In the model group,irregular arrangement and incomplete structure of intestinal mucosal villi;swollen glands,submucosal congestion and edema,and inflammatory cell infiltration were seen.Compared with the model group,the small intestine tissue damage was reduced in the traditional Chinese medicine enema group and soapy water group.However,the degree of damage in the traditional Chinese medicine enema group was significantly lighter than that in the soapy water enema group.5.Changes in serum inflammatory factors between the groups:There was no significant difference in serum inflammatory factor levels between the blank group,anesthesia group,and sham-operated group(P>0.05).Compared with the blank group,the level of TNFα,IL-6,IL-10 in the model group,traditional Chinese medicine enema group,soapy water enema group were all increased(P<0.05);Compared with the model group,the level of TNFα,IL-6 were decreased(P<0.05),and the levels of IL-10 were elevated in the traditional Chinese medicine enema group.6.Expression of c-kit positive ICC between the groups:There was no significant difference in the level of fluorescence intensity of c-kit positive ICC between the blank group,anesthesia group and sham-operated group(P>0.05).Compared with the blank group,the level of fluorescence intensity of c-kit positive ICC was significantly weaken in the model group,traditional Chinese medicine enema group and soapy water enema group(P<0.05).Compared with the model group,the level of fluorescence intensity of c-kit positive ICC was significantly increased in the traditional Chinese medicine enema group(P<0.05).Conclusion 1.The enema of TongfuJianpi soup can improve the general condition of EPISBO rats,and have a certain therapeutic effect on them.2.The efficacy of TongfuJianpi soup was significantly better than that of the soapy water enema group in reducing levels of serum inflammatory factor,decreasing ICC injury,reducing the degree of inflammatory response,alleviating intestinal adhesions,reducing intestinal mucosal damage,and improving general condition.3.The therapeutic mechanism of TongfuJianpi soup on EPISBO may be related to the inhibition of pro-inflammatory factor release,upregulation of anti-inflammatory factor expression,reduction of intestinal adhesions and intestinal mucosal damage,and reduction of ICC damage. |
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