Tonelli Francesco, Fedi Massimo, Paroli G Matteo, Fazi Marilena
Department of Clinical Physiopathology, University of Florence, Florence, Italy.
Dis Colon Rectum. 2004 Apr;47(4):494-501. doi: 10.1007/s10350-003-0084-8. Epub 2004 Feb 25.
Strictureplasty has commonly been used for short stenotic tracts, but it has rarely been applied to stenoses longer than 10 cm. Michelassi proposed a side-to-side isoperistaltic strictureplasty for single or multiple strictures that affected long bowel tracts. The experience and results obtained to date with this type of strictureplasty are limited. We therefore decided to review the cases in which we performed this procedure.
Thirty-one patients, aged 21 to 66 years, underwent this operation between August 1996 and October 2002. Indications for surgery included subocclusion in 22 patients, malnutrition in 9 patients, and fistula or abscess in 6 patients. Two side-to-side isoperistaltic strictureplasties have been performed in jejunum, 6 in jejunum-ileum, 16 in the proximal ileum, 1 in terminal ileum, and 6 in the ileo-cecal tract.
The average length of side-to-side isoperistaltic strictureplasty as 32.1 cm (range, 10-54 cm). Sixteen patients also underwent concomitant bowel resection and 17 patients have received additional strictureplasty. There was no perioperative mortality, nor were there any postoperative complications requiring reoperation. In all patients intestinal occlusion and malnutrition were resolved. Decrease of activity indices was observed in 62.3 percent of patients within 6 months after surgery. At an average follow-up of 26.4 months, six patients required reoperation, but in only one of them did the recurrence involve a previous strictureplasty site. In that case the side-to-side isoperistaltic strictureplasty was soft and was without signs of inflammation or stenosis.
Side-to-side isoperistaltic strictureplasty seems to provide a technical solution leading to improvement when long intestinal inflamed tract are treated. Longer follow-up and larger experience is needed to validate this observation.
狭窄成形术通常用于短狭窄段，但很少应用于长度超过10厘米的狭窄。米凯拉西提出了一种用于影响长肠段的单个或多个狭窄的侧侧等蠕动狭窄成形术。迄今为止，这种类型的狭窄成形术的经验和结果有限。因此，我们决定回顾我们实施该手术的病例。
1996年8月至2002年10月期间，31例年龄在21至66岁之间的患者接受了该手术。手术指征包括22例患者的不完全梗阻、9例患者的营养不良以及6例患者的瘘管或脓肿。在空肠进行了2例侧侧等蠕动狭窄成形术，在空肠-回肠进行了6例，在近端回肠进行了16例，在回肠末端进行了1例，在回盲部进行了6例。
侧侧等蠕动狭窄成形术的平均长度为32.1厘米（范围为10 - 54厘米）。16例患者同时进行了肠切除术，17例患者接受了额外的狭窄成形术。没有围手术期死亡，也没有需要再次手术的术后并发症。所有患者的肠梗阻和营养不良均得到解决。62.3%的患者在术后6个月内活动指数下降。平均随访26.4个月时，6例患者需要再次手术，但其中只有1例复发涉及先前的狭窄成形术部位。在该病例中，侧侧等蠕动狭窄成形术部位柔软，没有炎症或狭窄迹象。
侧侧等蠕动狭窄成形术似乎为治疗长段炎症性肠段提供了一种能带来改善的技术解决方案。需要更长时间的随访和更多经验来验证这一观察结果。
