Hetzer F H, Schwizer W, Kuenzi W, Demartines N
Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland.
Br J Surg. 2003 Oct;90(10):1273-9. doi: 10.1002/bjs.4270.
Use of dynamic myoplasty to create a continent stoma has produced promising results, but long-term stoma continence has not been achieved. The aim of the study was to establish and test a new model.
Three types of dynamic rectus abdominis sphincteroplasty around a colostomy and two conditioning protocols were tested in ten domestic pigs. Continence was assessed by means of conventional defaecography and neosphincter manometry after 8 and 12 weeks. The neosphincter muscle was studied histologically to assess the transformation of muscle type.
Use of a distal rectus muscle sling surrounding the stoma by 270 degrees with a low-frequency conditioning protocol achieved a continent colostomy for more than 12 h on each of 5 consecutive days. The neosphincter had a 40-mm high-pressure segment with mean pressure of 74 (range 67-82) mmHg. The proportion of type I muscle fibres increased from 38 (range 32-42) to 74 (range 66-78) per cent after 12 weeks of conditioning.
This pilot study demonstrated the feasibility of a continent stoma in an animal model with a dynamic rectus neosphincter. Long-term results should be confirmed in a larger series before use in humans can be considered.
采用动态肌成形术构建可控性造口已取得了有前景的结果，但尚未实现长期的造口可控性。本研究的目的是建立并测试一种新模型。
在10头家猪身上测试了围绕结肠造口的三种类型的动态腹直肌括约肌成形术以及两种调节方案。在8周和12周后，通过传统排粪造影和新括约肌测压法评估控便能力。对新括约肌进行组织学研究以评估肌肉类型的转变。
采用低频调节方案，用270度环绕造口的远端腹直肌吊带实现了连续5天每天超过12小时的可控性结肠造口。新括约肌有一个40毫米的高压段，平均压力为74（范围67 - 82）毫米汞柱。调节12周后，I型肌纤维的比例从38（范围32 - 42）%增加到74（范围66 - 78）%。
这项初步研究证明了在具有动态腹直肌新括约肌的动物模型中构建可控性造口的可行性。在考虑应用于人类之前，应在更大规模的系列研究中证实长期结果。
