Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
J Pediatr Surg. 2011 Jun;46(6):1045-51. doi: 10.1016/j.jpedsurg.2011.03.027.
In animal models, the small intestine responds to massive small bowel resection (SBR) through a compensatory process termed adaptation, characterized by increases in both villus height and crypt depth. This study seeks to determine whether similar morphologic alterations occur in humans after SBR.
Clinical data and pathologic specimens of infants who had both an SBR for necrotizing enterocolitis and an ostomy takedown from 1999 to 2009 were reviewed. Small intestine mucosal morphology was compared in the same patients at the time of SBR and at the time of ostomy takedown.
For all samples, there was greater villus height (453.6 ± 20.4 vs 341.2 ± 12.4 μm, P < .0001) and crypt depth (178.6 ± 7.2 vs 152.6 ± 6 μm, P < .01) in the ostomy specimens compared with the SBR specimens. In infants with paired specimens, there was an increase of 31.7% ± 8.3% and 22.1% ± 10.0% in villus height and crypt depth, respectively. There was a significant correlation between the amount of intestine resected and the percent change in villus height (r = 0.36, P < .05).
Mucosal adaptation after SBR in human infants is similar to what is observed in animal models. These findings validate the use of animal models of SBR used to understand the molecular mechanisms of this important response.
在动物模型中，小肠通过一种称为适应性的代偿过程对大量小肠切除术（SBR）作出反应，其特征在于绒毛高度和隐窝深度均增加。本研究旨在确定 SBR 后人类是否会出现类似的形态改变。
回顾了 1999 年至 2009 年间因坏死性小肠结肠炎而行 SBR 并接受造口还纳术的婴儿的临床数据和病理标本。在 SBR 时和造口还纳时，对同一患者的小肠黏膜形态进行了比较。
对于所有标本，造口标本的绒毛高度（453.6±20.4μm 比 341.2±12.4μm，P<0.0001）和隐窝深度（178.6±7.2μm 比 152.6±6μm，P<0.01）均大于 SBR 标本。在具有配对标本的婴儿中，绒毛高度和隐窝深度分别增加了 31.7%±8.3%和 22.1%±10.0%。小肠切除量与绒毛高度百分比变化之间存在显著相关性（r=0.36，P<0.05）。
人类婴儿 SBR 后的黏膜适应性与在动物模型中观察到的相似。这些发现验证了使用 SBR 动物模型来理解这一重要反应的分子机制的有效性。
