Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America.
Department of Surgery, Division of Pediatric Surgery, School of Medicine, Stanford University, Stanford, California, United States of America.
PLoS One. 2018 Jul 12;13(7):e0200529. doi: 10.1371/journal.pone.0200529. eCollection 2018.
Spring-mediated distraction enterogenesis has been studied as a novel treatment for short bowel syndrome (SBS). Previous approaches are limited by multiple surgeries to restore intestinal continuity. Purely endoluminal devices require a period of intestinal attachment for enterogenesis. The purpose of this study is to modify the device to prevent premature spring migration in a porcine model. Two models were created in juvenile mini-Yucatan pigs for the placement of three-dimensionally printed springs. (1) Two Roux-en-y jejunojenostomies with two Roux limbs were made. A spring with bidirectional hooked surface features was placed in one Roux limb and a spring with smooth surface was placed in the other Roux limb. (2) The in-continuity model had both hooked and smooth surface springs placed directly in intestinal continuity. Spring location was evaluated by weekly radiographs, and the intestine was retrieved after 2 to 4 weeks. Springs with smooth surfaces migrated between 1 to 3 weeks after placement in both porcine models. Springs with bidirectional hooked surface features were anchored to the intestine for up to 4 weeks without migration. Histologically, the jejunal architecture showed significantly increased crypt depth and muscularis thickness compared to normal jejunum. Bidirectional features printed on springs prevented the premature migration of endoluminal springs. These novel spring anchors allowed for their endoluminal placement without any sutures. This approach may lead to the endoscopic placement of the device for patients with SBS.
春介导的肠诱导术已被研究作为治疗短肠综合征（SBS）的一种新方法。以前的方法受到恢复肠道连续性的多次手术的限制。纯腔内器械需要一段时间的肠附着来进行肠诱导。本研究的目的是修改该设备，以防止在猪模型中过早出现春移。在幼年迷你尤卡坦猪中创建了两种模型，以放置三维打印的弹簧。（1）制作了两个 Roux-en-y 空肠空肠吻合术，每个 Roux 分支有两个 Roux 分支。在一个 Roux 分支中放置具有双向钩状表面特征的弹簧，在另一个 Roux 分支中放置具有光滑表面的弹簧。（2）连续模型中直接在肠连续性中放置了具有钩状和光滑表面的弹簧。通过每周的射线照相评估弹簧的位置，并在 2 至 4 周后取回肠道。在两个猪模型中，具有光滑表面的弹簧在放置后 1 至 3 周内迁移。具有双向钩状表面特征的弹簧在没有迁移的情况下可固定在肠内长达 4 周。组织学上，与正常空肠相比，空肠结构显示出明显增加的隐窝深度和肌层厚度。打印在弹簧上的双向特征可防止腔内弹簧过早迁移。这些新型弹簧固定器允许在没有任何缝线的情况下腔内放置。这种方法可能会导致 SBS 患者内镜下放置该设备。
