Department of Pediatric Surgery, Josa Andras Hospital Nyíregyháza, Teaching Hospital of Medical Health Science Centre University of Debrecen, Hungary.
J Pediatr Surg. 2013 Sep;48(9):1907-13. doi: 10.1016/j.jpedsurg.2013.01.048.
Spiral Intestinal Lengthening and Tailoring (SILT) offers a new opportunity for the surgical treatment of short bowel syndrome. SILT requires less manipulation on the mesentery than the Bianchi procedure and does not alter the orientation of the muscle fibers like serial transverse enteroplasty (STEP). This study reports the first SILT results in a surviving animal model.
Vietnamese minipigs (n=6) underwent interposition of a reversed intestinal segment to produce proximal small bowel dilation. Five weeks later the reversed segment was resected, and the wall of the dilated intestine was cut spirally at 45°-60° to its longitudinal axis. The bowel was lengthened longitudinally, and the spiral shaped intestinal wound was sutured. Five weeks later, the animals were explored, and the lengthened segments were measured. Haematoxylin and eosin, picrosirius, neuron specific enolase, S-100, C-kit, and immunohistochemistry were performed.
Mean lengthening was 74.8% ± 29.5% and mean tailoring (lumen reduction) was 56.25% ± 18.8%. No instances of necrosis, perforation, suture break down, or peritonitis were observed in 6/6 animals. Four of six animals recovered uneventfully with viable lengthened segments. Statistical analysis showed no significant difference in length (p=0,078) and width (p=0,182) after 5 weeks. Two animals developed bowel obstruction due to narrowed lumen, adhesion, and strangulation after 14 and 24 days of surgery. In both animals the lumen was tailored by more than 70% to less than 1.5 cm diameter. The mucosa and the muscle layers in the operated segment had become hypertrophic, but the orientation of the circular and longitudinal muscle fibres remained normal after the SILT procedure. There were no signs of chronic ischemia or collagen accumulation after the SILT. The myenteric and submucosal plexuses and the Cajal cell network appeared normal.
The bowel remained viable macroscopically and microscopically after SILT, such that SILT may be an alternative or an addition to the present technical repertoire of intestinal lengthening. However the limitations of tailoring should be kept in mind.
螺旋肠延长和裁剪（SILT）为短肠综合征的治疗提供了新的机会。与 Bianchi 手术相比，SILT 对肠系膜的操作较少，并且不像连续横向肠成形术（STEP）那样改变肌纤维的方向。本研究报告了首例在存活动物模型中进行的 SILT 结果。
越南小型猪（n=6）接受了反转肠段的介入以产生近端小肠扩张。5 周后切除反转段，并以 45°-60°的角度沿其纵轴切割扩张肠的壁。肠被纵向延长，螺旋形肠切口缝合。5 周后，对动物进行探查，并测量延长段。进行苏木精和伊红、苦味酸、神经元特异性烯醇化酶、S-100、C-kit 和免疫组织化学染色。
平均延长率为 74.8%±29.5%，平均裁剪（管腔缩小）率为 56.25%±18.8%。6/6 只动物均未出现坏死、穿孔、缝线断裂或腹膜炎。6 只动物中有 4 只动物恢复良好，有存活的延长段。统计分析显示，5 周后长度（p=0.078）和宽度（p=0.182）无显著差异。2 只动物由于术后 14 天和 24 天发生管腔狭窄、粘连和绞窄而发生肠梗阻。在这两只动物中，管腔被裁剪至直径小于 1.5cm，裁剪率超过 70%。手术后，手术段的黏膜和肌层已发生肥厚，但 SILT 手术后环形和纵形肌纤维的方向仍保持正常。SILT 后无慢性缺血或胶原积累的迹象。肌间和黏膜下丛以及 Cajal 细胞网络均正常。
SILT 后肠在宏观和微观上仍保持存活，因此 SILT 可能是目前肠延长技术的替代或补充。但是，应该注意裁剪的局限性。
