Kang Kuang Horng-Jamie, Gutierrez Ivan M, Zurakowski David, Diperna Stephanie, Buonomo Carlo, Kim Heung Bae, Jaksic Tom
Department of Surgery, Center of Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA.
Pediatr Surg Int. 2012 Dec;28(12):1189-93. doi: 10.1007/s00383-012-3212-5. Epub 2012 Nov 16.
The serial transverse enteroplasty (STEP) operation tapers and lengthens dilated small bowel. Some patients demonstrate bowel re-dilation following STEP. Factors associated with bowel re-dilation and its effect upon clinical outcome were evaluated.
Twenty STEP operations were reviewed. Sixteen cases were operated for failure to advance enteral feeding and were further analyzed. Available pre- and post-STEP radiographs were independently assessed for bowel re-dilation by two experienced pediatric radiologists. Potential factors of re-dilation were evaluated. Full enteral autonomy was defined as no longer requiring parenteral nutrition (PN) and remaining off PN for at least 12 months after STEP.
There was complete concordance between the radiologists. 9 of 16 patients demonstrated radiographic bowel re-dilation following STEP. Age, follow-up duration, time interval between STEP and last imaging reviewed, gender, diagnoses, pre- and post-STEP bowel length and width were not significantly associated with re-dilation. However, median post-STEP duration of PN was significantly longer in the re-dilated group than in the non-dilated group (41 vs. 3 months, p = 0.006). In addition, only 1 of 9 re-dilated patients achieved enteral autonomy as compared with 6 of 7 non-dilated patients (p = 0.009).
Longer PN duration after STEP increases probability of bowel re-dilation. Patients who re-dilated following STEP are significantly less likely to achieve enteral autonomy. Larger prospective data collections are warranted to further explore these relationships.
系列横断肠成形术（STEP）可使扩张的小肠变窄并延长。一些患者在STEP术后出现肠管再次扩张。本研究评估了与肠管再次扩张相关的因素及其对临床结局的影响。
回顾了20例STEP手术病例。其中16例因肠内营养推进失败而接受手术，并进行进一步分析。两名经验丰富的儿科放射科医生独立评估STEP术前和术后可用的X光片，以判断肠管是否再次扩张。评估再次扩张的潜在因素。完全肠内自主定义为不再需要肠外营养（PN），且在STEP术后至少12个月内无需PN。
放射科医生之间的评估完全一致。16例患者中有9例在STEP术后X光片显示肠管再次扩张。年龄、随访时间、STEP与最后一次影像学检查的时间间隔、性别、诊断、STEP术前和术后肠管长度及宽度与再次扩张均无显著相关性。然而，再次扩张组术后PN的中位持续时间显著长于未扩张组（41个月对3个月，p = 0.006）。此外，9例再次扩张患者中只有1例实现了肠内自主，而7例未扩张患者中有6例实现了肠内自主（p = 0.009）。
STEP术后较长的PN持续时间会增加肠管再次扩张的可能性。STEP术后出现肠管再次扩张的患者实现肠内自主的可能性显著降低。需要更大规模的前瞻性数据收集来进一步探索这些关系。
