Name: murine ileocolic bowel resection with primary anastomosis
Uploaded: 2014-10-29T14:00:00.000+00:00
Duration: 8 min 49 s
Description: Watch this Scientific Journal Video about Murine Ileocolic Bowel Resection with Primary Anastomosis at JoVE.com

We would like to acknowledge the funding contributions of the Canadian Surgical Research Fund, the Edmonton Civic Employees Research Assistance Fund, and the Alberta IBD Consortium through a grant from Alberta Innovates.

動物使用プロトコルはアルバータ大学の健康科学動物管理使用委員会によって承認された。 楽器、動物および手術のセットアップの調製<ol><li>手続きの前に、すべての固形食24 hrの新しい、クリーンなケージ不在に動物を転送します。彼らは、手続きの時間になるまで水に自由にアクセスし、液体ダイエットアドリブを持っている場合があります。 </li><li>手続きに必要なすべての楽器をオートクレーブ。クリーン操作面、70％エタノールで麻酔ノーズコーン。 </li><li>執刀医のための快適な方法で手術用顕微鏡、麻酔器や電源で操作面を設定します。外科医の肘、手と用具を遮るもののない腕で、手術台の上で快適休ませなければならない。楽器、縫合糸、綿棒、および10ミリリットルの注射器は、手順の間に簡単にアクセスを許可した場所に配置する必要があります。 </li><li>セットアップオーバーヘッド加熱ランプは、操作面の手順と光の間の動物のための暖かさの両方を提供する。 </li><li> 0.9％食塩水で50ml円錐管、および操作面の近くにワセリンと場所との1.5mlチューブを埋める。 注：すべての楽器や外科用品を滅菌する。腸が離断されているので、手続き自体は無菌ではありません。これは、クリーンで汚染されたと考えられている。感染の外因性源の導入を回避するための措置をとる。 </li></ol>吻合2.回結腸切除術<ol><li>動物の呼吸数が約30〜40回/分に減速するまで、イソフルラン気化器からノーズコーンを介して、2リットル/分の酸素流量で4％イソフルランを投与することにより麻酔を誘導する。手順を開始する前に、痛みの応答がないことを確認するには、マウスの後肢足に適度な圧力を適用します。この時点で、0.5L /分に2％イソフルランと酸素の流れを下げてください。断続的に処置中に痛みの応答を確認し、それに応じて、イソフルラン流量を調節。 </li><li>手術中の乾燥を防止し、透明テープを用いて固定手足と仰臥位でマウスを固定化するために眼にワセリンを適用する。 </li><li> povodine /ヨウ素溶液で腹部をきれいにし、新しい滅菌手袋に着替える。 </li><li>筋膜と腹膜を露出するためにハサミを解剖鋭いポイントを使用して腹部の上部正中1.5センチの皮膚切開を行います。腹膜内容を公開する白線を通して同様の方法で筋膜/腹膜層を開きます。 </li><li>ヒトとは対照的に、マウスの盲腸は、典型的には、腹部の左上腹部に見られる。特定されたら、優しく鉗子で盲腸を把握し、切開を通してそれを実現します。腹部の表面にドレープ滅菌ガーゼ（ 図1A）上で盲腸から延びるファンアウトに回腸末端の約3cmを湿らせた綿棒を使用してください。暴露腸がプロシージャの全体の間に0.9％生理食塩水で湿った保たれていることを確認。 </li><li>手術用顕微鏡を用いて、コロン（ 図1A）に沿って上腸間膜動脈から分岐回盲動脈を識別します。回盲動脈に隣接する無血管組織を切開、5-0絹のネクタイで動脈を包囲し、連結する。次に、回腸末端に地域の血液供給を見つけ、回盲部に離断点1.5-2センチ近位の順に選択します。上記のように回腸のこのセクションに枝を結紮。はさみを解剖ミクロと動脈を分割します。 </li><li>離断終了する（ 図1B）に十分な血液供給があるの確保回腸および結腸の虚血性部分を分ける。それはより密接にコロンと一致するように内腔の直径を増加させるために30度の角度で分割して回腸をへらすることがしばしば有用である。腸の回盲部が除去されて、一度、整列各腸間膜の国境を確保ガーゼ上の回腸および結腸の離断端は、整列している。 </li><li> 8-0ポリプロピレン縫合糸（ 図1C）を使用して中断し、コロンの離断最後に回腸の離断終わりを近似することにより吻合を構築します。最初のステッチは、回結腸吻合水密になるまで、すべての0.5ミリメートルを置いその後の縫合糸で、腸間膜の国境に配置されます。回腸および結腸を通して縫合針を渡すとき、切り口がロールバックされていないことを確認し、針に刺されは、腸の切断端から0.5ミリメートルである。典型的な吻合は14から16に中断縫合が必要になります。吻合を通じて内容を強制的に回腸遠位の上、綿棒の近位を圧延することにより完了時に吻合の整合性と開存性をテストします。小腸の内容は自由に吻合漏れなく結腸に渡す必要があります。 </li><li> 10ミリリットルの注射器から0.9％食塩水3〜4 mlの暴露腸をすすぐ腸の表面から糞便を洗い流し、および腹腔内に戻って腸を提供します。 0.9％生理食塩水2 mlを用いて、腹膜腔を洗浄し、次いで横方向に腹壁に穏やかな圧力を適用することによって、この流体を排出する。 </li><li> 3-0絹ランニング縫合糸で切開を閉じ、イソフルランの流れを中止してください。術後疼痛管理のために-buprenorphine-皮下に長時間作用性アヘン剤の0.1 mg / kgをを管理します。 </li><li>彼らがモバイルになるまで継続的に温めてケージに転送した後、熱ランプの下で動物を観察します。 </li></ol> 3.術後ケアとモニタリング<ol><li>その日の残りのための苦痛の徴候のために継続的に温めケージに動物を監視します。背中流動食と水アドリブへのアクセス権を持つ新たな無菌ケージ内の動物飼育施設に動物を転送します。動物は3-4の群で収容することができる。 </li><li>翌朝術後動物のチェックを実行し、動物は苦痛には表示されないように。唯一の流動食を供給。彼らは不快に表示された場合（ すなわち、猫背の姿勢、または最小活性）皮下ブプレノルフィンの追加の用量を投与。術後1日目の午後に一回より多くの動物に確認してください。 </li><li>術後2日目の朝に動物が完全に回復し表示されるはずです。食料消費とstoolingの証拠は回復の明るい兆しである。さて、動物用固形飼料食を再開します。 注：苦痛の徴候は​​猫背の姿勢、貧しいグルーミング、および最小限のアクティビティが含まれます。苦痛の徴候が顕著である場合には、動物を安楽死させなければならない。 </li><li>動物が足圧に反応しないようになるまで2 L / minのO 2流量で4％イソフルランで深く麻酔を誘発することによって動物を安楽死させる。頸椎脱臼を行い、適切な安楽死の兆候を観察する。 </li><li>ガイドラインは異なりますので、適応症に関する機関の勧告を参照してください。用とマウスでの安楽死の適切な方法。 </li></ol>

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The authors have nothing to disclose

ICRマウスは、腸疾患における手術の効果を研究するために使用できる強力なモデルである。この記事では、95％の成功率と28日後の手順まで安定重みによって反映されるように成長障害と問題なくマウスではICRを行う方法を説明しています。成功したICRへの最も重大な課題は、吻合と吻合リークで腸閉塞を避けることが含まれる。 閉塞を防ぐための手術への技術要素は吻合で内腔の直径の最大化を目的としている。離断点における回腸のスパチュラは、 図1Aに示すように30度の角度で腸を分割して管腔直径を増大させる。縫合針と腸組織の咬傷をとる場合には、腸の端部にアンロールし、約0.5mmの切断端から針を通過させることが不可欠である。組織の過大刺さは、内腔を狭めます。 AVするオプション吻合を構築するキールナンら 15によって記載されるように消化性ステントの使用を採用することであるoidは管腔狭窄。障害物を回避するための非技術的な側面が十分に小さい縫合糸4を選択し、手術前と手術後2日以内に1日、動物に流動食を供給することによりかさばる管腔内容を避けることが含まれる。 術後死亡率の第二の最も一般的な原因は、吻合部の漏れである。この合併症を回避することは、腸吻合の原則を厳守する必要があります。一番乗り十分な血液供給。切除された腸の領域に血液を供給する血管が結紮された後、腸を視覚的に前に離断に点検してください。腸の虚血性セグメントは薄暗い表示されます。これは完全に健康的なエッジを残して除去されるべきである。これは、残りの腸の切断端から少量の出血を可視化することが重要である。水タイトアナスtomosisは、敗血症に至る管腔内容物の流出を避けるためにも不可欠である。これは、縫合糸の間に大きなギャップを回避し、かつ腸のすべての層がステッチ（ 図3）に含まれていることを保証することによって達成される。巻か強度が大幅に最初の二つの術後日間で減少している、このように適切に配置縫合糸は強度16,17を提供することが不可欠です。不注意だけ粘膜などの粘膜を含めている潜在的な落とし穴は、離断大腸の内腔の外にしわができます。これは、漿膜の切り口を可視化し、静かに鉗子で管腔への脱出粘膜を低減することによって回避することができる。 偽の外科手術のコントロールは、外科的ストレス、腸の操作、および/または、回盲弁の損失の潜在的な交絡効果を制御するためのICRモデルを用いた研究の実験設計において考慮されるべきである。偽手順の選択はで求められている主要な問題に依存することになる研究。研究の目的は、回盲弁を失った後、宿主応答を評価することである場合、それは代わりに、回盲弁を残したまま腸吻合が行われる偽手術群を含むことが賢明であろう。これは、典型的切除、その後回結腸吻合7,11と同じ方法で小腸の吻合を実行せずに小腸を離断することにより行われる。これは研究者は、腸吻合の影響を制御することにより、特に盲弁の損失の影響についてコメントすることを可能にする。別の方法としての目標は、回盲弁の損失に特にコメントすることなく腸切除および吻合の影響を研究するためだけであれば、その後偽手術は、開腹を含め​​るべきであり、腸は、ICRの場合と同じように扱われますが、離断なしべきであると吻合。これは、外科的ストレスと腸の操作のために制御する。に記載された技術プロトコルは、上記の簡単に偽の手順を実行するために適合させることができる。 このプロトコルは、回腸末端と盲腸の全体1.5-2センチ取り除き回結腸切除術を、説明し、密接に頻繁に回結腸クローン病の患者で行われた操作を模倣。 - / -マウスは、クローン病の再発7,11に類似した小腸自発炎症および線維症を開発した後の大腸炎モデルは同様の手順をIL-10で使用されてきた。この手順の原理は、疾患の他のモデルに適用される場合があります。回結腸吻合と小腸の50％を除去することにより、マウスモデルは、短腸症候群4-6適応腸の成長応答を調査するために使用されている。将来的には、これはまた、結腸直腸癌における手術の全身および局所的効果を研究するための有用なモデルになることがあります。

Ileocolic resection (ICR) is a common procedure performed in both emergent and elective situations for a variety of illnesses. Crohn&#8217;s disease and colon cancers are the two most common indications for ICR. In both illnesses, recurrence in the bowel at the site of surgery represents a major clinical problem. Local recurrence rates for colon cancer remain an issue even with the most aggressive resections1. Following ICR in Crohn&#8217;s disease, the disease most frequently (in up to 80%) recurs in the neo-terminal ileum at 1 year after surgery2. Given the impact of these two illnesses and their recurrence after surgery, it is important to understand local intestinal factors after ICR, which may have intrinsic influences on the natural history of these diseases. Further, it is also important to consider anastomotic healing after ICR. In the early post-operative period, anastomotic leaks can have devastating consequences for patients resulting in repeat surgeries, stoma creations, significant morbidity, and even mortality3. Despite the importance of this topic, our current understanding of anastomotic healing remains in its infancy as a subject of research. Animal models of ICR, in particular mice, are an excellent platform for studying the intestinal and anastomotic healing following surgery.
A mouse model of ICR was initially developed by Helmrath et al. to be used as a model of short gut syndrome4. The authors experimented with various diet regiments and suture sizes to optimize animal survival following ICR. They concluded that feeding with liquid diet in the perioperative period and using 9-0 monofilament sutures resulted in an optimal post-operative survival of 88%. Since this initial publication, ICR in mice removing 50% of the small bowel has been used in several studies to explore the dynamics of massive small bowel resection and the adaptive growth response in attempt to develop new therapies for short gut syndrome5,6.
The first application of the ICR mouse model to Crohn&#8217;s disease used the IL-10-/- mouse model, which spontaneously develops colitis7. The authors found that after ICR these animals developed inflammation in the neo-terminal ileum similar to that seen in post-operative Crohn&#8217;s disease patients, and that this inflammation was dependent on the presence of bacteria7. More recently, this model was used to explore bacterial changes induced by ICR. In Crohn&#8217;s disease there is an associated dysbiosis with relative decreases in bacteria known to have anti-inflammatory properties and increases in invasive species of bacteria8,9. The association holds true in cases of post-operative recurrence10. Two studies sought to identify microbial changes resulting from ICR. The first used IL-10 null mice, and performed denaturing gel electrophoresis to compare bacterial similarity between the small bowel and colon after ICR11. This study demonstrated that bacterial populations became similar in the small intestine and colon following ICR. A subsequent study used wild type mice and 16s pyrosequencing for phylogenetic classification of bacterial species post-operatively. This study demonstrated a marked shift in bacterial species resulting from surgery alone with Clostridium species becoming dominant as well as an increase in &#978;-proteobacteria. The results also confirmed the findings of the previous study with similar populations found in the small bowel and colon after ICR12. 
ICR is a common procedure for patients with colon cancer involving the cecum and ascending colon, and it is becoming increasingly recognized that the host-response to surgery likely contributes to both local and distant tumor recurrence13. Despite this observation, models of ICR have not been utilized for the study of colorectal cancer and post-operative recurrence. Understanding both the systemic and local immunologic changes resulting from ICR will be important in investigating future therapies. Potential pathways involved in cancer recurrence post ICR include up regulation of growth factors, which may rescue cells from apoptosis and stimulate proliferation, mechanical tumor disruption with cell shedding, and loss of immune surveillance through post-operative immunosuppression13,14. 
Mouse models of ICR have the potential to be a powerful tool for the investigation of short bowel syndrome, Crohn&#8217;s disease, and colon cancer. They may also provide lessons on how to prevent early post-operative anastomotic complications by further defining the cellular and biochemical pathways involved in healing the newly constructed anastomosis. A major barrier in utilizing the murine ICR model is the technical difficulty. The intestinal anastomosis requires the use of 8-0 or 9-0 suture, an operating microscope, and training in microsurgical techniques. The goal of this article is to provide clear instructions on how to perform ICR in mice with the goal of utilizing this procedure in models of disease.

<table><tbody><tr><td>LD101 liquid rodent diet</td><td>testdiet.com</td><td></td><td></td></tr><tr><td>0.9% NaCl</td><td>Baxter</td><td>FKE1324</td><td>Injection quality saline</td></tr><tr><td>Operating Microscope</td><td>Ziess</td><td></td><td></td></tr><tr><td>Isoflurane Anesthetic Vaporizer</td><td>Harvard Apparatus</td><td>34-0483</td><td></td></tr><tr><td>Isoflurane</td><td>Abbott&amp;nbsp;</td><td>05260-05</td><td></td></tr><tr><td>Glass plate</td><td></td><td></td><td>For operating surface</td></tr><tr><td>Cotton swabs</td><td></td><td></td><td></td></tr><tr><td>Micro Castroviejo Needle holder, curved</td><td>World Precision Instruments</td><td>503377</td><td></td></tr><tr><td>Castroviejo straight scissors</td><td>World Precision Instruments</td><td>555530S</td><td></td></tr><tr><td>Dissecting Scissors</td><td>World Precision Instruments</td><td>15922</td><td></td></tr><tr><td>Dressing Forceps x 2</td><td>World Precision Instruments</td><td>500363</td><td></td></tr><tr><td>5-0 silk pre-cut sutures</td><td>Ethicon</td><td>A182H</td><td>For vessel ligation</td></tr><tr><td>8-0 Prolene on BV130-5 needle</td><td>Ethicon</td><td>8732H</td><td>For anastomosis</td></tr><tr><td>3-0 Silk on FS-2 needls</td><td>Ethicon</td><td>8665G</td><td>For abdominal wall closure</td></tr><tr><td>Petroleum Jelly</td><td>Vaseline</td><td></td><td></td></tr><tr><td>10 ml syringe</td><td>BD biosciences</td><td></td><td></td></tr><tr><td>Povidone-iodine 7.5% surgical Scrub</td><td>&lt;a href=&quot;http://betadine.com&quot;&gt;betadine.com&lt;/a&gt;</td><td></td><td></td></tr><tr><td>Heat lamps</td><td></td><td></td><td></td></tr><tr><td>buprenorphine 0.3 mg/ml</td><td>Reckitt Benckiser Healthcare Ltd.&amp;nbsp;</td><td>PL36699/0006</td><td></td></tr></tbody></table>

murine ileocolic bowel resection with primary anastomosis

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease.

死亡率と体重変化術後。 129S1野生型マウスをICRに続く死亡率は〜5％、一般的である。道徳の最も一般的な原因は、吻合で腸閉塞である。死亡率の他の原因は、吻合部の漏れや閉塞を腸につながる内部ヘルニアが含まれています。 体重減少は術後14日まで見られるが、一般的に非有意であることができます。マウスが完全に術後28日目（ 図2）によって術前体重を回復する傾向がある。 技術の転写 新しい大学院生（BM）は、以前の外科的訓練を受けたオペレータはテクニックを学ぶことができるかどうかを判断するためのICR手​​順を実行するために教えられた。訓練は、8-0ナイロン縫合糸を使用して吻合に使用されるものと類似の単一結節縫合を実行する方法を学ぶことから始まりました。縫合糸は、ラテックスGLOまたがっ切開を閉じるために行われたVEの。 BMは効率的に裂けることなく手袋を通して縫合糸を配置することができた後、彼らはいずれかを試みる前に、3つの完全な手順を観察した。最初の手順が完了した後、それらは、別の手順を観察し、さらに2つを試みた。完成した3匹の動物のうち、最後の二つは生き残り、繁栄するようになった。最初の動物に起因吻合での合併症に安楽死させた。 <img alt="図1" src="/files/ftp_upload/52106/52106fig1highres.jpg" /> 回結腸切除術および吻合図1.ステージ。腹部の外に配信腸の（A）回盲部。黒い矢印は、破線はコロンと回腸末端のために離断点を示し、ライゲートさせるべき血管を示している。 （B）を除去回盲部は、腸の切断端部は、残りの血液供給は、黒の矢印によって示される、整列される。 （C）完了回結腸アナスtomosis。 <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/52106/52106fig1large.jpg" target="_blank">この図の拡大版をご覧になるにはこちらをクリックしてください。</a> <img alt="図2" src="/files/ftp_upload/52106/52106fig2highres.jpg" /> マン·ホイットニーU統計的検定によって決定されるように、ベースラインで、図2動物の体重は、手術後14日目および術後28日目に体重の有意な変化は、後手順を認められなかった。 ICR（回結腸切除群）、コントロール（非動作制御）する。 <img alt="図3" src="/files/ftp_upload/52106/52106fig3highres.jpg" /> 腸組織を通して縫合糸の図3.代表パス。H＆Eは、回腸（右）とコロン（左）縫合NEの軌跡を実証するために並んでいるの組織切片を染色組織を通してedle（破線）の点（b）にまで（a）の時点で開始する。結び目は、（c）の時点で接続しなければなりません。あまり粘膜が他の組織よりも吻合に含まれていることに注意してください。 <a href="https://www-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/52106/52106fig3large.jpg" target="_blank">この図の拡大版をご覧になるにはこちらをクリックしてください。</a>

Watch this Scientific Journal Video about Murine Ileocolic Bowel Resection with Primary Anastomosis at JoVE.com

Murine Ileocolic Bowel Resection with Primary Anastomosis

Ileocolic resection is commonly performed in several human diseases; however, little is known regarding the impact of intestinal resection on surgical illnesses. This article provides instruction on executing the procedure in mice with high success, providing a means to study the effects of ileocolic resection in models of disease.

プライマリ吻合とネズミ回結腸腸切除

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

murine-ileocolic-bowel-resection-with-primary-anastomosis

Universidad San Sebastian

Research

JoVE Journal

Medicine

16.3K ビュー.  University of Alberta. Ileocolic resection is commonly performed in several human diseases; however, little is known regarding the impact of intestinal resection on surgical illnesses. This article provides instruction on executing the procedure in mice with high success, providing a means to study the effects of ileocolic resection in models of disease.

ビデオ: Murine Ileocolic Bowel Resection with Primary Anastomosis

Small Bowel Transplantation In Mice

Since 1990, the development of tacrolimus-based immunosuppression and improved surgical techniques, the increased array of potent immunosuppressive medications, infection prophylaxis, and suitable patient selection helped improve actuarial graft and patient survival rates for all types of intestine transplantation. Patients with irreversible intestinal failure and complications of parenteral nutrition should now be routinely considered for small intestine transplantation. However, Survival rates for small intestinal transplantation have been slow to improve compares increasingly favorably with renal, liver, heart and lung. The small bowel transplantation is still unsatisfactory compared with other organs. Further progress may depend on better understanding of immunology and physiology of the graft and can be greatly facilitated by animal models. A wider use of mouse small bowel transplantation model is needed in the study of immunology and physiology of the transplantation gut as well as efficient methods in diagnosing early rejection. However, this model is limited to use because the techniques involved is an extremely technically challenging. We have developed a modified technique. When making anastomosis of portal vein and inferior vena cava, two stay sutures are made at the proximal apex and distal apex of the recipient s inferior vena cava with the donor s portal vein. The left wall of the inferior vena cava and donor s portal vein is closed with continuing sutures in the inside of the inferior vena cava after, after one knot with the proximal apex stay suture the right wall of the inferior vena cava and the donor s portal vein are closed with continuing sutures outside the inferior vena cave with 10-0 sutures. This method is easier to perform because anastomosis is made just on the one side of the inferior vena cava and 10-0 sutures is the right size to avoid bleeding and thrombosis.  In this article, we provide details of the technique to supplement the video.

The mouse small bowel transplantation model has been recognized as an important tool to study mechanismes of immune rejection and screen new immunosuppressive drugs. However, this model is limited to use because the techniques involved is an extremely technically challenge. Now we introduce the modified technique.

マウスにおける小腸移植

Since 1990, the development of tacrolimus-based immunosuppression and improved surgical techniques, the increased array of potent immunosuppressive ...

生物学

Ileectomy-induced Bile Overaccumulation in Mouse Intestine

Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer that often results in severe short bowel syndrome-like adverse effects including bile acid diarrhea, dehydration, electrolyte disturbances, and nutrient malabsorption. Here we introduce a murine ileal resection model, termed ileectomy, to evaluate tissue communication and the maintenance of systemic homeostasis. After ileal resection, circulating blood is permanently devoid of the ileum-specific endocrine hormone fibroblast growth factor 15 (FGF15), which releases its endocrinal inhibition of bile acid synthesis in the liver. In combination with the increased production and abolished reabsorption of bile acids after removing the ileum, mice that underwent surgery suffer from bile salt overaccumulation in the intestine and associated diarrhea, morbidity, and mortality. Novel usage of the surgery model introduced in this study may provide mechanistic and functional insights into ileal control of systemic metabolic regulation in physiology and disease.

Small intestine-dependent bile acid reabsorption and feedback inhibition of hepatic bile acid synthesis is important for systemic homeostasis and health. In this study, we describe a mouse model for ileal resection to evaluate ileectomy-induced bile malabsorption, overaccumulation, and toxicity in mouse intestine.

マウス腸管で胆汁の回腸誘起蓄積

Intestinal resection is a common therapeutic approach for human diseases such as obesity, inflammatory bowel disease, Crohn's disease, and colon cancer ...

医学

Murine Distal Colostomy, A Novel Model of Diversion Colitis in C57BL/6 Mice

Diversion colitis (DC) is a frequent clinical condition occurring in patients with bowel segments excluded from the fecal stream as a result of a diverting enterostomy. The etiology of this disease remains ill-defined but appears to differ from that of classical inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. Research aimed to decipher the pathophysiological mechanisms leading to the development of this disease has been severely hampered by the lack of an appropriate murine model. This protocol generates a murine model of DC that facilitates the study of the immune system's role and its interaction with the microbiome in the development of DC. In this model using C57BL/6 animals, distal parts of the colon are excluded from the fecal stream by creating a distal colostomy, triggering the development of mild to moderate inflammation in the excluded bowel segments and reproducing the hallmark lesions of human DC with a moderate systemic inflammatory response. In contrast to the rat model, a large number of genetically-modified murine models on the C57BL/6 background are available. The combination of these animals with our model allows the potential roles of individual cytokines, chemokines, or receptors of bioactive molecules (e.g., interleukin (IL)-17; IL-10, chemokine CXCL13, chemokine receptors CXCR5 and CCR7, and the sphingosine-1-phosphate receptor 4) to be assessed in the pathogenesis of DC. The availability of congenic mouse strains on the C57BL/6 background largely facilitates transfer experiments to establish the roles of distinct cell types involved in the etiology of DC. Finally, the model offers the opportunity to assess the influences of local interventions (e.g., modification of the local microbiome or local anti-inflammatory therapy) on mucosal immunity in affected and non-affected bowel segments and the on systemic immune homeostasis.

Murine distal colostomy provides a murine model for human diversion colitis, a predominantly lymphocytic colitis in colon segment excluded from the fecal stream.

マウスの遠位人工肛門、転用 c57bl/6 マウス大腸炎の新たなモデル

Diversion colitis (DC) is a frequent clinical condition occurring in patients with bowel segments excluded from the fecal stream as a result of a ...

Creation of Colonic Anastomosis in Mice

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of colonic surgeries and can occur in up to 26% of surgical anastomoses, with mortality being up to 39% for patients with such a leak. Currently, there remains a paucity of data detailing the cellular mechanisms of anastomotic healing. Devising preventative strategies and treatment modalities for anastomotic leak could be greatly potentiated by a better understanding of appropriate anastomotic healing.
A murine model is ideal as previous studies have shown that the murine anastomosis is the most clinically similar to the human case as compared with other animal models. We offer an easily reproducible murine model of colonic anastomosis in mice that will allow for further illustration of anastomotic healing.

Anastomotic leak or breakdown after surgery is a major cause of postoperative morbidity and mortality. Our surgery for creating a colonic anastomosis is a reliable and reproducible method for studying the healing mechanisms of anastomoses.

マウスの消化管吻合の作成

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of ...

Robotic Radical Cystectomy, Pelvic Lymph Node Dissection, and Intracorporeal Ileal Conduit Urinary Diversion

The robotic approach to radical cystectomy is compelling because of its oncologic equivalence to open radical cystectomy (ORC), its association with lower surgical blood loss, its potential association with shorter hospital stay after surgery. These factors suggest that the robotic approach to radical cystectomy may be an important component of enhanced recovery programs aimed at reducing surgical morbidity. This paper describes the importance of the cranial placement of robotic trocars, the use of Cadiere forceps for atraumatic bowel grasping, pelvic lymph node dissection (PLND), and utero-enteric anastomoses. Also discussed are steps that are critical for the successful outcome of RARC. In spite of the increased operating times and associated costs and the costs of robotic surgical platforms and equipment, adoption of the robotic technique by bladder cancer surgeons has increased. This paper describes a systematic and reproducible method that details robotic extended pelvic lymph node dissection, cystectomy/cystoprostatectomy, and intracorporeal ileal conduit urinary diversion.

This paper describes robotic radical cystectomy, pelvic lymph node dissection, and intracorporeal ileal conduit urinary diversion.

The robotic approach to radical cystectomy is compelling because of its oncologic equivalence to open radical cystectomy (ORC), its association with lower ...

<meta charset="utf8"></head><body>腸管操作による術後イレウス研究のためのマウスモデル

Postoperative Ileus Murine Model

Most patients experience postoperative ileus (POI) after surgery, which is associated with increased morbidity, mortality, and hospitalization time. POI is a consequence of mechanical damage during surgery, resulting in disruption of motility in the gastrointestinal tract. The mechanisms of POI are related to aberrant neuronal sensitivity, impaired epithelial barrier function, and increased local inflammation. However, the details remain enigmatic. Therefore, experimental murine models are crucial for elucidating the pathophysiology and mechanism of POI injury and for the development of novel therapies.
Here, we introduce a murine model of POI generated via intestinal manipulation (IM) that is similar to clinical surgery; this is achieved by mechanical damage to the small intestine by massaging the abdomen 1-3 times with a cotton swab. IM delayed gastrointestinal transit 24 h after surgery, as assessed by FITC-dextran gavage and fluorescence detection of the segmental digestive tract. Moreover, tissue swelling of the submucosa and immune cell infiltration were investigated by hematoxylin and eosin staining and flow cytometry. Proper pressure of the IM and a hyperemic effect on the intestine are critical for the procedure. This murine model of POI can be utilized to study the mechanisms of intestinal damage and recovery after abdominal surgery.

<meta charset="utf8"></head><body>術後イレウスマウスモデル

We describe a murine model of postoperative ileus generated via intestinal manipulation. Gastrointestinal transit function, pathologic changes, and immune cell activation were assessed 24 h after surgery.

術後イレウスマウスモデル

Most patients experience postoperative ileus (POI) after surgery, which is associated with increased morbidity, mortality, and hospitalization time. POI ...

免疫・感染学

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

局所進行中低直腸癌に対するロボット支援全中腸切除および横骨盤リンパ節切断

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...

Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Model in Mice

Obesity is a major health issue worldwide. As a response, bariatric surgeries have emerged to treat obesity and its related comorbidities (e.g., diabetes mellitus, dyslipidemia, non-alcoholic steatohepatitis, cardiovascular events, and cancers) through restrictive and malabsorptive mechanisms. Understanding the mechanisms by which these procedures allow such improvements often require their transposition into animals, especially in mice, because of the ease of generating genetically modified animals. Recently, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a procedure that uses both restrictive and malabsorptive effects, which is being used as an alternative to gastric bypass in case of major obesity. Thus far, this procedure has been associated with strong metabolic improvements, which has led to a marked increase in its use in daily clinical practice. However, the mechanisms underlying these metabolic effects have been poorly studied as a result of a lack of animal models. In this article, we present a reliable and reproducible model of SADI-S in mice, with a special focus on perioperative management. The description and use of this new rodent model will be helpful for the scientific community to better understand the molecular, metabolic, and structural changes induced by the SADI-S and to better define the surgical indications for clinical practice.

Single-anastomosis duodeno-ileal bypass (SADI-S) is an emerging bariatric procedure with important metabolic effects. In this article, we present a reliable and reproducible model of SADI-S in mice.

マウスにおけるスリーブ状胃切除モデルを用いた単一吻合十二指腸回腸バイパス術

Obesity is a major health issue worldwide. As a response, bariatric surgeries have emerged to treat obesity and its related comorbidities (e.g., diabetes ...

プライマリ吻合とネズミ回結腸腸切除

要約

さらに動画を探す

この動画の章

マウスにおける小腸移植

マウス腸管で胆汁の回腸誘起蓄積

マウスの遠位人工肛門、転用 c57bl/6 マウス大腸炎の新たなモデル

マウスの消化管吻合の作成

Robotic Radical Cystectomy, Pelvic Lymph Node Dissection, and Intracorporeal Ileal Conduit Urinary Diversion

術後イレウスマウスモデル

術後イレウスマウスモデル

術後イレウスマウスモデル

局所進行中低直腸癌に対するロボット支援全中腸切除および横骨盤リンパ節切断

マウスにおけるスリーブ状胃切除モデルを用いた単一吻合十二指腸回腸バイパス術