Sheth J, Sharif K, Lloyd C, Gupte G, Kelly D, de Ville de Goyet J, Millar A J, Mirza D F, Chardot C
Liver Unit (including small bowel transplantation), Birmingham Children's Hospital, Birmingham, UK.
Pediatr Transplant. 2012 Feb;16(1):36-40. doi: 10.1111/j.1399-3046.2011.01597.x. Epub 2011 Oct 9.
Following paediatric SBMT, size discrepancy between the recipient's abdomen and the graft may lead to ACS, graft dysfunction, and death. We report our experience with SAC in these patients. Between 04/1993 and 03/2009, 57 children underwent 62 SBMTs. When abdominal wall tension seemed excessive for safe PAC, SAC was performed, using a Silastic® sheet and a vacuum occlusive dressing. Transplantations with SAC (23 combined liver and small bowel [CLB]) were compared with those with PAC [14 ISB and 25 CLB]. Indications for transplantation, preoperative status (after stratification for ISB/CLB transplants), age at transplantation, donor-to-recipient weight ratio, reduction in bowel and/or liver, and incidence of wound complications were not different in both groups. Post-operative intubation, stay in intensive care unit, and hospital stay were prolonged after SAC. Two deaths were related to ACS after PAC, none after SAC. Since 2000, one-yr patient survival is 73% after ISB transplantation and 57% vs. 75% after CLB transplantation with PAC vs. SAC, respectively (NS). SAC safely reduces severe ACS after paediatric SBMT and can be combined with graft reduction for transplantation of small recipients.
小儿小肠移植术后，受者腹部与移植物之间的大小差异可能导致腹腔间隔室综合征（ACS）、移植物功能障碍和死亡。我们报告了我们在这些患者中应用腹腔造口术（SAC）的经验。1993年4月至2009年3月期间，57名儿童接受了62次小肠移植。当腹壁张力似乎过大而无法进行安全的一期吻合术（PAC）时，采用硅橡胶片和负压封闭敷料进行SAC。将接受SAC的移植（23例肝小肠联合移植[CLB]）与接受PAC的移植（14例孤立小肠移植[ISB]和25例CLB）进行比较。两组在移植指征、术前状态（ISB/CLB移植分层后）、移植年龄、供受者体重比、肠和/或肝的缩小情况以及伤口并发症发生率方面无差异。SAC术后的术后插管时间、重症监护病房停留时间和住院时间延长。PAC术后有2例死亡与ACS相关，SAC术后无死亡。自2000年以来，ISB移植术后1年患者生存率为73%，CLB移植采用PAC和SAC术后分别为57%和75%（无显著性差异）。SAC可安全降低小儿小肠移植术后严重ACS的发生率，并且可与移植物减容联合用于小体型受者的移植。
