PDF(Pubmed)
Abstract：
Anastomotic stricture is a typical complication of esophageal atresia surgery. Remote ischemic conditioning (RIC) has demonstrated multiorgan benefits, however, its efficacy in the esophagus remains unclear. This study aimed to investigate whether applying RIC after esophageal resection and anastomosis in rats could attenuate esophageal stricture and improve inflammation. Sixty-five male Sprague-Dawley rats were categorized into the following groups: controls with no surgery, resection and anastomosis only, resection and anastomosis with RIC once, and resection and anastomosis with RIC twice. RIC included three cycles of hind-limb ischemia followed by reperfusion. Inflammatory markers associated with the interleukin 6/Janus kinase/ signal transducer and activator of transcription 3 (IL-6/JAK/STAT3) and tumor necrosis factor-alpha/nuclear factor-κB (TNF-α/NF-kB) signaling pathways were evaluated with RNA and protein works. The RIC groups showed significantly lower stricture rates, lower inflammatory markers levels than the resection and anastomosis-only group. The RIC groups had significantly lower IL-6 and TNFa levels than the resection and anastomosis-only group, confirming the inhibitory role of remote ischemic conditioning in the IL-6/JAK/STAT3 and TNF-α/NF-kB signaling pathways. RIC after esophageal resection and anastomosis can reduce the inflammatory response, improving strictures at the esophageal anastomosis site, to be a novel noninvasive intervention for reducing esophageal anastomotic strictures.
摘要：
吻合口狭窄是食管闭锁手术的典型并发症。远程缺血适应（RIC）已经证明了多器官的益处，然而,其在食管中的疗效尚不清楚。本研究旨在探讨大鼠食管切除吻合术后应用RIC能否减轻食管狭窄和改善炎症反应。将65只雄性Sprague-Dawley大鼠分为以下几组：未手术的对照组，仅切除和吻合，RIC切除吻合一次,切除吻合术和RIC两次。RIC包括三个周期的后肢缺血和再灌注。通过RNA和蛋白质作用评估与白细胞介素6/Janus激酶/信号转导和转录激活因子3（IL-6/JAK/STAT3）和肿瘤坏死因子-α/核因子-κB（TNF-α/NF-kB）信号通路相关的炎症标志物。RIC组的狭窄率明显较低，炎症标志物水平低于仅切除和吻合组。RIC组的IL-6和TNFα水平明显低于单纯切除吻合组,证实远程缺血调节在IL-6/JAK/STAT3和TNF-α/NF-kB信号通路中的抑制作用。食管切除吻合术后RIC可减轻炎症反应，改善食管吻合部位的狭窄，成为减少食管吻合口狭窄的新型无创干预措施。
