Coletta Riccardo, Aldeiri Bashar, Morabito Antonino
Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom.
Department of Paediatric Surgery, Universita Degli Studi di Firenze Scuola di Scienze Della Salute Umana, Firenze, Toscana, Italy.
Eur J Pediatr Surg. 2019 Oct;29(5):412-416. doi: 10.1055/s-0038-1660850. Epub 2018 Jun 19.
The aim of this study was to report our initial experience using spiral intestinal lengthening and tailoring (SILT) technique in selected cases of short bowel syndrome (SBS).
We analyzed all cases of SBS underwent SILT in our unit since the introduction of the procedure in 2012. We retrospectively analyzed patients' demographics, pre- and postprocedure bowel length, surgical complications, and postoperative parenteral nutrition (PN) requirements. Data were compared using independent samples, Mann-Whitney's -test.
Five children with SBS underwent SILT between 2012 and 2017. Median age at procedure was 8.3 months (4.5-16). Preoperative small bowel length measured a median of 22 cm (17.5-50) with a median diameter of 4 cm (3.5-4.6). SILT allowed a median increase in length of 56% (10-15 cm; = 0.03) and tailoring of the dilated segment providing a reduction in diameter of 50% (4.3-2.1 cm; = 0.01). No major complications related to SILT were encountered and none of the children required further surgical intervention following a median follow-up of 26 months (14.5-41). Interestingly, we observed a significant reduction of PN requirement at 6 months ( = 0.008) associated with liver function preservation during the follow-up period.
In our experience, SILT is a promising adjunct in the surgical management of SBS. It can be used to tailor and lengthen mildly dilated segments of the bowel where other procedures are technically challenging, with a view to reduce the risk of intestinal failure associated liver disease and thereby improving chances for quality survival. Further studies are needed to investigate long-term outcomes of SILT in pediatric SBS.
本研究的目的是报告我们在选定的短肠综合征（SBS）病例中使用螺旋肠延长和剪裁（SILT）技术的初步经验。
我们分析了自2012年该手术引入以来在我们科室接受SILT治疗的所有SBS病例。我们回顾性分析了患者的人口统计学资料、术前和术后的肠长度、手术并发症以及术后肠外营养（PN）需求。使用独立样本曼-惠特尼U检验对数据进行比较。
2012年至2017年间，5例SBS患儿接受了SILT治疗。手术时的中位年龄为8.3个月（4.5 - 16个月）。术前小肠长度中位值为22 cm（17.5 - 50 cm），中位直径为4 cm（3.5 - 4.6 cm）。SILT使肠长度中位增加了56%（10 - 15 cm；P = 0.03），并对扩张段进行剪裁，使直径减小了50%（4.3 - 2.1 cm；P = 0.01）。未遇到与SILT相关的重大并发症，在中位随访26个月（14.5 - 41个月）后，没有患儿需要进一步的手术干预。有趣的是，我们观察到在6个月时PN需求显著降低（P = 0.008），且在随访期间肝功能得以保留。
根据我们的经验，SILT是SBS手术治疗中一种有前景的辅助方法。在其他手术在技术上具有挑战性的情况下，它可用于剪裁和延长轻度扩张的肠段，以降低与肠衰竭相关的肝病风险，从而提高优质生存的机会。需要进一步研究来调查SILT在小儿SBS中的长期疗效。
