Ralls Matthew W, Sueyoshi Ryo, Herman Richard, Utter Brent, Czarnocki Isabel, Luntz Jonathan, Brei Diann, Teitelbaum Daniel H
Section of Pediatric Surgery, Department of Surgery and the C.S, Mott Children's Hospital, University of Michigan, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI 48109-4211, USA.
Pediatr Surg Int. 2013 Feb;29(2):151-6. doi: 10.1007/s00383-012-3198-z.
Distraction-induced intestinal growth may be a novel treatment for short bowel syndrome. Longitudinal, distractive tension created by the application of force creates a significant challenge: to produce adequate force, yet not cause perforation at the fixation points. This paper describes our development of a coupling strategy to allow for successful bowel lengthening.
A curvilinear hydraulic device was implanted in an isolated Roux limb of small bowel in young Yorkshire pigs. Bowel was lengthened over a 2-week period. Study groups included: Group 1: Twelve silk transmural anchoring sutures into an engineered-coupling ring at the ends of each device. Group 2: Addition of felt pledgets to the coupling rings on the serosal surface of the small bowel. Group 3: Extraluminal use of either thin AlloDerm(®), thick AlloDerm(®), or Strattice™ mesh to anchor the device.
Group 1 (suture-only) resulted in a gradual pulling through the suture with increasing tension and no lengthening. Felt pledgets eroded in a similar fashion, causing abdominal sepsis. Thin AlloDerm(®) failed to prevent erosion; however, it protected against gross contamination. Animals in which either thick AlloDerm(®) or Strattice™ mesh was used survived complication free to the study endpoint. Both thick AlloDerm(®) and Strattice™ prevented erosion and perforation allowing for an average of 10.85 cm expansion.
This study demonstrates the use of either thick AlloDerm(®) or Strattice™ reconstructive tissue matrix which allows for safe and effective coupling. Further, we suggest this approach could be an adjunct to esophageal lengthening procedures.
牵引诱导肠生长可能是治疗短肠综合征的一种新方法。施加力产生的纵向牵引张力带来了重大挑战：要产生足够的力，同时又不会在固定点处导致穿孔。本文描述了我们开发的一种耦合策略，以实现成功的肠延长。
将一个曲线液压装置植入幼年约克夏猪的一段孤立的小肠Roux袢中。在2周的时间内使肠延长。研究组包括：第1组：在每个装置的末端将12根丝线经壁锚定缝合线缝合到一个工程耦合环中。第2组：在小肠浆膜表面的耦合环上添加毡垫。第3组：在管腔外使用薄的AlloDerm®、厚的AlloDerm®或Strattice™网片来固定装置。
第1组（仅缝合线）随着张力增加，缝合线逐渐被拉出，未实现延长。毡垫以类似方式侵蚀，导致腹腔感染。薄的AlloDerm®未能防止侵蚀；然而，它可防止严重污染。使用厚的AlloDerm®或Strattice™网片的动物无并发症存活至研究终点。厚的AlloDerm®和Strattice™均防止了侵蚀和穿孔，平均实现了10.85厘米的扩张。
本研究证明了使用厚的AlloDerm®或Strattice™重建组织基质可实现安全有效的耦合。此外，我们认为这种方法可能是食管延长手术的一种辅助方法。
