| ObjectiveTo further discuss the regulative effects and its mechanism of acupuncture on abdominal postoperative gastrointestinal dysmotility, this research used the 3-Leg point in Jin'3-needle technique to prevent abdominal postoperative gastrointestinal dysmotility. In the clinical research part comparison of traditional acupuncture and electroaucpuncture was made in order to enrich acupuncture treatment modality on abdominal postoperative gastrointestinal dysmotility. And this also benefits to inheritance of traditional culture in TCM. The controlled and randomized clinical research part could offer a strong surpport of evidence-based medicine to acupuncture treatment on abdominal postoperative gastrointestinal dysmotility. The experimental research part made gastric movement's pacemaking cell ICC (interstitial cell of Cajal) as the incision, comprehensively studied the mechanism of acupuncture on abdominal postoperative gastrointestinal dysmotility from different aspects, for example, the number and ultrastructure of ICC, the network structure of ENS-ICC-SMC, the gene expression of SCF mRNA in Kit-SCF system, blood gastrointestinal hormone, inflammatory reponse of gastrointestinal tissue, etc. This could offer a scientific theoretical basis to further clinical application of acupuncture treatment on abdominal postoperative gastrointestinal dysmotility.MethodLiterature researchReviewed literatures of clinical and experimental research on postoperative gastrointestinal dysmotility in the past 20 years, summarized the understanding of domestic and foreign scholars on postoperative gastrointestinal dysmotility, the study methods of gastrointestinal movement, the machanism study and the treatment progress in this field. Analysed the literature by using the method of systematic review.Clinical research105 patients was selected out strictly according to the diagnostic criteria and inclusive and exclusive criteria in gastrointestinal surgery and hepatobiliary surgery department of the No.l Affiliated Hospital of Guangzhou University of TCM. They were divided randomly into traditional acupuncture group, electroacupuncture group and blank group by means of random number table, each group 35 persons. The 3-Leg point in Jin'3-needle technique(Zusanli, Sanyinjiao, Taichong) was used in both acupuncture group and electroacupuncture group.The acupuncture operation of traditional acupuncture group was to insert the needle perpendicularly into the point, hold the needle lightly by using thumb, forefinger and midfinger waiting for Qi. When Qi arrived, made discrimination and compared it with the differentiation of symptoms and signs, then did aucupuncture manipulation, reinforced deficiency and reduced excess by lifting and thrusting the needle. If there was no deficiency or excess, the manipulation of guiding Qi was used coordinately with regulating patient's breathing. Inserted the needle to certain depth while the patient breathed once, then lifted it to the surficial layer while patient breathed again. Manipulation was done 2 min per time each point. The total treatment lasted 30minutes. In the electroacupuncture group Zusanli and Taichong were given electrol stimulation. Zusanli was connected to cathode while Taichong was connected to anode. Sanyinjiao was not given electrol stimulation. Used rarefaction wave, impulse frequency was 2Hz, current was 1-2mA, according to patient's tolerence. The total treatment lasted 30minutes. Both traditional acupuncture group and electroacupuncture group were treated twice a day till the patient exhausted. The longest treatment lasted 5 days. Stop treating when 5 day came though the patient still didn't exhaust. Blank group had no acupuncture treatment.Obsevred and recorded the time of first exhaust, first defecation after operation, the time began to take liquid diet, the time bowelsound appeared and recover, classification of abdominal distension and pain, classification of gastrointestinal reaction, etc. Analyzed and did statistics.Experimental research40 rats were devieded randomly into acupuncture group, model group, sham-operation group and blank group, each group 10 rat. Rats in acupuncture group and model group were given colon transection and anastomosis. Rats in sham-operation group were given open abdominal operation. Both acupuncture group and sham-operation group were given acupuncture treatment when came round after operation. The 3-Leg point in Jin'3-needle technique (Zusanli, Sanyinjiao, Taichong) was used. Inserted the needle and do manipulation like lifting and thrusting, twirling and rotating 2-3 times every 5 minutes. The treatment lasted 15 minutes and was given once a day for 3 days. The model group and blank group were trapped into the same self-made fixator for 15min each day.Observed and recorded the time of first defecation after operation, everyday's granule and weight of excrement in the first 3 days after operation. Radionuclide scanning on gastric emptying was taken on the forth day after operation to observe the gastric emptying. Rats were killed and the blood was taken to detect plasma MLT and seru GAS. Tissue in pacemaking eara of gas, which was in the middle part of gas 1/3 from cardia and tissue of colon which was 2cm under caecum (anastomosis part) were taken and divided into 4 parts: one was used to make pathology section to observe the inflammatory reponse; one was used to make frozen section, do immunofluorescence double labeling combined with confocal microscopic to observe the network structure of ENS-ICC-SMC; one was used to make electron microscope specimen to observe ultrastructure of ICC; the last one was used to detect gene expression of SCF mRNA and CALM1 mRNA by RT-PCR.ResultClinical research1. The time of first exhaust after operation:The time in traditional acupuncture group was significantly shorter than that in blank group(P<0.05). While the difference between traditional acupuncture group and electroacupuncture group, the difference between electroacupuncture group and blank group, had no significant meaning(P>0.05).2. The time of first defecation after operation:The time in traditional acupuncture group was significantly shorter than that in blank group and electroacupuncture group(P<0.05). The quality of first defecation in traditional acupuncture group was also significantly better than that in electroacupuncture group(P<0.0125).3. The time began to take liquid diet:Both the traditional acupuncture group (P<0.05) and the electroacupuncture group(P<0.01) had signifucantly difference with blank group. And the difference between traditional acupuncture group and blank group was more significant.4. Bowelsound:The time bowelsound from appeared to recovered had significant difference between traditional acupuncture group and blank group, electroacupuncture group and blank group(P<0.05). While there was no significant difference between traditional acupuncture group and electroacupuncture group(P>0.05). The grade change from before and after treatment in both traditional acupuncture group and electroacupuncture group was significantly greater than that in blank group(P<0.01).5. Grade of abodaomimal distension and pain:The grade change from before and after treatment in electroacupuncture group was significantly greater than that in blank group(P<0.05).6. Grade of gastrointestinal reaction:The grade change from before and after treatment in electroacupuncture group was significantly greater than that in blank group(P<0.05).7. Effecacy evaluation:The symptoms score change from before and after treatment in traditional acupuncture group(P<0.01) and electroacupuncture group(P<0.05) was significantly greater than that in blank group. The therapeutic index of traditional acupuncture group and electroacupuncture group was significantly greater than that in blank group(P<0.01). The traditional acupuncture group had significant difference with blank group in therapeutic grade constitution and total effective rate(P<0.01).8. Correlation analyze of the first exhaust time and acupuncture inervention time:The first exhaust time was seen as y, the acupuncture inervention time was seen as x, according to curve fitting, such equation was get:y=x1.4 (50.05) in both GET1/2 and 60min emptying rate.3. Blood gastrointestinal hormone change:The plasma MLT was significantly less in model group than that in blank group and acupuncture group(P<0.01). There was no significant difference between acupuncture group and blank group(P>0.05). There was no significant difference of seru GAS among the four groups(P>0.05).4. The pathological morphology change of gastrointestinal tissue observed under microscope:The inflammation and hydroncus was most serious in model group. Acute and chronic inflammatory cells soaked. Granuloma was seen. The inflammation and hydroncus in acupuncture group was not so serious. Thread ends and foreign body reaction was seen in both model group and acupuncture group. Mucosa ulcer existed.5. The gastrointestinal ENS-ICC-SMC network structure change:The number of ICC and the fluorescence intensity was greatly decreased in model group compared to blank group(P<0.05). The synapsis were not obvious. The integrated network structure disappear, huge vacancy was found. The tightness connects between ICCs, ICC and SMC, ICC and nerve fibre were deficient. Cholinerqic nerve network structure was seriously imcomplete, present schistose distribution. Connect between nerve fibre were greatly decreased. VAChT positive nerve fibre was obviously reduced, the fluorescence intensity was significantly weaken compared to blank group. The distribution of ICC and cholinerqic nerve was nonuniform. The ENS-ICC-SMC structure was confused. The ICC distribution in acupuncture group was kept network structure. The synapsis were seen. The connections of ICCs, ICC and SMC, ICC and and nerve fibre were tight and there were no obvious gaps. The number of ICC and the fluorescence intensity were increased compared to the model group(P<0.05) and there were no difference with blank group. VAChT positive nerve fibre was obviously increased compared to model group. The network structure was kept and connects between cholinerqic nerves were tight. The fluorescence intensity was significantly stronger than model group(P<0.05) and there were no difference with blank group. Long tubers between ICC and cholinerqic nerve increased. Connect structure was integrated. Network structure existed.6. The gastrointestinal ICC ultrastructure change under electron microscope:The nucleus of ICC in model group contracted, heterochromatin appeared near the nucleus membrance shaped like spot. Tubers were greatly decreased and the tip fractured, cytoplasm content were lost. Vacuole was formed in cytoplasm. The number of organelle was greatly reduced, the structure of organelle was abnormal:the number of mitochondria decreased, mitochondria swelled and dissolved, ridge broke, vacuole formed; endoplasmic reticulum expanded, rough surfaced endoplasmic reticulum dropped granule; lots of intermediate fiber evacuation; large lipid droplet and empty membrane concrement vacuole was seen; secondary lysosome increased, closely related with fused lipid droplet and cluster glycogen grain; basement membrane was incompleted. Some cytoplasm ultrastructure was hard to identified. The nucleus of ICC in acupuncture group kept normal shape. Damage of tubers was not obvious. Heterochromatin partly appeared near the nucleus membrance. Lots of mitochondrion, ribosome, endoplasmic reticulum and Gorky existed. The shape and structure of organelle was clear. A few mitochondrion swelled. some endoplasmic reticulum expanded. basement membrane was completed7. The gene expression of SCF mRNA change:The gene expression of SCF mRNA was significantly less in model group than that in blank group(P<0.01) and acupuncture group(P<0.05). There was no significant difference between acupuncture group and blank group(P>0.05).8. Correlation analyze of plasma MLT and gastrointestinal emptying:MLT was seen as x, the GET1/2, gas emptying rate and granule of excrement were seen as y, according to curve fitting, such equations were get: y=165.179-0.732x(0 |
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