Piper Hannah, Modi Biren P, Kim Heung Bae, Fauza Dario, Glickman John, Jaksic Tom
Department of Surgery, Children's Hospital Boston and the Harvard Center for Minimally Invasive Surgery, Harvard Medical School, Boston, MA 02115, USA.
J Pediatr Surg. 2006 Dec;41(12):1951-6. doi: 10.1016/j.jpedsurg.2006.08.015.
Serial transverse enteroplasty (STEP) lengthens and tapers dilated bowel. Redilation of the STEP segment occurs in some patients with intestinal failure. The feasibility of a repeat STEP procedure in a pig model is evaluated.
Six pigs underwent reversal of an intestinal segment distal to the ligament of Treitz. At 6-week intervals after reversal, each animal had 2 STEP procedures on the bowel proximal to the reversed segment. Necropsy was performed up to 6 weeks after repeat STEP.
Bowel length increased by 11.3 +/- 3.9 cm and bowel diameter decreased from a mean of 5.3 +/- 0.8 to 1.8 +/- 0.4 cm (P < .0001) after the first STEP. After repeat STEP, bowel length increased by 16.7 +/- 13.3 cm (P < .01), and the bowel was tapered from a mean of 5.4 +/- 0.9 to 2.2 +/- 0.4 cm (P < .01). Five pigs did well after repeat STEP, and 1 pig had early necropsy for bowel obstruction. None had histologic evidence of bowel ischemia in the repeat STEP segment.
A second STEP operation is feasible in a pig model and may be considered to optimize bowel length and function in select patients with intestinal failure.
系列横断肠成形术（STEP）可延长并缩窄扩张的肠管。部分肠衰竭患者的STEP肠段会再次扩张。本研究评估了在猪模型中重复进行STEP手术的可行性。
6只猪接受了Treitz韧带远端肠段的翻转术。翻转术后每隔6周，每只动物在翻转段近端的肠管上进行2次STEP手术。重复STEP术后6周内进行尸检。
首次STEP术后，肠管长度增加了11.3±3.9 cm，肠管直径从平均5.3±0.8 cm降至1.8±0.4 cm（P <.0001）。重复STEP术后，肠管长度增加了16.7±13.3 cm（P <.01），肠管从平均5.4±0.9 cm缩窄至2.2±0.4 cm（P <.01）。5只猪在重复STEP术后情况良好，1只猪因肠梗阻提前进行了尸检。重复STEP肠段均无肠缺血的组织学证据。
在猪模型中进行第二次STEP手术是可行的，对于特定的肠衰竭患者，可考虑采用该手术来优化肠管长度和功能。
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