| ObjectiveIn this study,the model of gastrectomy in rats was established and perioperative nutrition management with enteral nutrition of enhanced recovery after surgery(ERAS)was implemented.The microstructure and ultrastructure of the intestinal mucosal barrier in rats were observed.Immunohistochemistry and qTR-PCR were used to detect the intestinal mucosa tight junction proteins,including Claudin-1,Occludin and ZO-1.In addition,gastric cancer patients with gastrectomy underwent perioperative nutritional management of ERAS and diamine oxidase(DAO),D-lactic acid(D-LA)and intestinal fatty acid binding protein(IFABP)in peripheral blood were detected to investigate the effect of perioperative nutrition management of ERAS on the structure and function of the intestinal barrier after gastrectomy.MethodsThe gastrectomy model of rats was established,of which 20 rats implemented the ERAS perioperative nutrition management with enteral nutrition(ERAS rat group),and 20 rats implemented the traditional perioperative nutrition management with parenteral nutrition(traditional rat group).Ileal specimens of 10 rats in each group were taken out at 24 h and 72 h after operation,and 10 normal rats(normal rat group)were used as controls.All ileal specimens were used for pathological examination,and the pathological scores of intestinal mucosa of each group were compared.Meanwhile,protein and mRNA of Claudin-1,Occludin and ZO-1 in the intestinal mucosa were detected by immunohistochemistry and qTR-PCR respectively.The ileum specimens of 3 rats were randomly selected from each group for observation of the ultrastructural changes of intestinal mucosal barrier with ransmission electron microscope.In addition,22 patients of gastrectomy with gastric cancer underwent ERAS perioperative nutrition management(ERAS group)and 20 patients of gastrectomy with gastric cancer underwent traditional perioperative nutrition management(traditional group).Levels of plasma DAO,D-LA,IFABP at the time before operation and 1 day,3days and 5 days after operation were detected.Results(1)Under light microscope,the intestinal mucosa of rats showed different degrees of damage after gastrectomy,manifesting as the the space under intestinal mucosal epithelial cells increased and the epithelial cell layer separated from the lamina propria.In severe cases,the villi were destroyed and shed.However,the intestinal mucosa pathological scores of the ERAS rat group at 24 hours and 72 hours after surgery were lower than those of the traditional rat group respectively(P <0.05).(2)The ultrastructure of intestinal epithelial cells showed that the intestinal epithelial cells of the traditional rat group were necrotic and the microvilli were shed at 24 hours after surgery.In the ERAS rat group,the microvilli were partially shed at 24 hours after the operation,but the structure of epithelial cells and the organelle were clear,while the boundary of epithelial cell was blurred.In the traditional rat group,the microvilli were shortened at 72 hours after surgery,and the tight junction between epithelial cells was almost disappeared.In the ERAS rat group,the microvilli were slightly shorter,and the tight junction was present but partially interrupted at 72 hours after operation.(3)Intestinal mucosal immunohistochemistry showed that Claudin-1 was expressed in the membrane of intestinal epithelial cells;Occludin was expressed linearly along the villi margin;ZO-1 was expressed in the cytoplasm.Analysis by Image J software showed that,compared with the normal rat group,the optical density of Claudin-1,Occludin and ZO-1 decreased in the traditional rat group and the ERAS rat group at 24 hours after operation(P <0.05).The optical densities of the traditional rat group and the ERAS rat group at 72 hours after surgery were higher than those at 24 hours after surgery(P <0.05),and the optical density of the ERAS rat group at 72 hours after surgery was higher than that of the traditional rat group at 72 hours after surgery(P<0.05).(4)Compared with the normal rat group,the mRNA expression of Claudin-1,Occludin and ZO-1 decreased at 24 h after operation in the traditional rat group and the ERAS rat group(P<0.05),and their quantitatives of the traditional rat group were lower than those of the ERAS rat group(P <0.05).The mRNA expressions of each protein in the traditional rat group and the ERAS rat group at 72 hours after operation were higher than those at 24 hours after operation(P<0.05),and the mRNA expression of the ERAS rat group at 72 hours after operation was higherthan that of the traditional rat group at 72 hours after operation.(5)Of the all patients with gastric cancer,plasma DAO,D-LA at 1 day,3 days and 5 days after gastrectomy were higher than those of preoperative levels(P <0.05),and plasma IFABP at1 day after operation was higher than that of preoperative level(P <0.05).Plasma DAO levels in ERAS group were lower than those of the traditional group at the 1 day,3 days,and 5 days after operation(P <0.05).Plasma D-LA levels in ERAS group were lower than those of the traditional group at 3 days and 5 days after surgery(P<0.05).The plasma IFABP levels in the ERAS group were lower than those of the traditional group at 1 day and 3 days after surgery(P <0.05).ConclusionGastrectomy can cause damage to the structure and function of intestinal barrier.The implementation of perioperative nutrition management of ERAS can promote the earlier recovery of structure and function of intestinal barrier. |
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