Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki 889-1692, Japan.
Dis Colon Rectum. 2009 Nov;52(11):1882-6. doi: 10.1007/DCR.0b013e3181b11487.
Side-to-side strictureplasty is a useful procedure for preserving the bowel in patients with Crohn's disease. However, bowel resection is required in some patients, and diseased proximal bowel and disease-free distal bowel exist after resection. We performed a modified new technique called side-to-side-to-end strictureplasty.
Four patients with Crohn's disease underwent this procedure. After resection of the diseased bowel that was not suitable for strictureplasty, side-to-side strictureplasty was performed with use of the proximal diseased loop. Thereafter, the distal end of the side-to-side stricture was anastomosed to the distal disease-free bowel in a side-to-side-to-end manner.
The length of the small intestine requiring surgical intervention was 69.8 +/- 26.4 (mean +/- standard deviation) cm, and the length of the small intestine necessitating resection was 31.8 +/- 12.6 cm. Side-to-side stricture was performed by use of 48.8 +/- 20.2 cm of the diseased proximal bowel, which was anastomosed to the disease-free distal bowel. Intra-abdominal abscess, which was not associated with this procedure, was observed in one patient, but was treated by drainage. The recoveries of all four patients were uneventful, without recurrence, after a follow-up of 21.5 +/- 16.2 months.
Side-to-side-to-end strictureplasty may be a useful procedure when diseased proximal bowel and disease-free distal bowel are present after bowel resection in patients with Crohn's disease.
对于患有克罗恩病的患者，侧侧狭窄成形术是一种保留肠道的有用方法。然而，一些患者需要进行肠道切除术，且切除后存在病变近端肠道和无病变的远端肠道。我们采用了一种改良的新技术，称为侧侧端侧狭窄成形术。
4 例克罗恩病患者接受了该手术。切除不适合狭窄成形术的病变肠道后，使用近端病变肠环进行侧侧狭窄成形术。然后，侧侧狭窄的远端以侧侧端侧的方式与无病变的远端肠道吻合。
需要手术干预的小肠长度为 69.8 +/- 26.4（平均值 +/- 标准差）cm，需要切除的小肠长度为 31.8 +/- 12.6 cm。使用 48.8 +/- 20.2 cm 的病变近端肠进行侧侧狭窄，与无病变的远端肠吻合。1 例患者出现与该手术无关的腹腔脓肿，但通过引流治疗。4 例患者的恢复均顺利，在随访 21.5 +/- 16.2 个月后无复发。
当克罗恩病患者的肠道切除后存在病变近端肠道和无病变的远端肠道时，侧侧端侧狭窄成形术可能是一种有用的方法。
