Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
J Gastrointest Surg. 2019 Feb;23(2):331-338. doi: 10.1007/s11605-018-3893-8. Epub 2018 Aug 8.
Small bowel transplantation (SBTX) in children receiving larger grafts from adults can be challenging because of size mismatch. The aim of the present study was to assess whether a simultaneous serial transverse enteroplasty (STEP) can address the problem of size mismatch.
Three different size ratio groups between donors and recipients were compared in a porcine model with a 14-day follow-up. The groups were size matched, size mismatched (1:3.8 weight ratio), and size mismatched + STEP (each n = 8).
It was technically feasible to simultaneously perform a STEP and SBTX of a mismatched intestinal segment. The postoperative clinical course was uneventful. No signs of bleeding, leakage, stenosis, or ileus were observed and the intestinal segment was well perfused at relaparotomy. Body weight decreased in all groups, but the percentage decrease was lowest in the mismatched + STEP group. Vital enterocyte masses were similar in all the groups (citrulline levels) and the nutritional status was best in the STEP group (transferrin levels, p = 0.04).
We have demonstrated that a simultaneous STEP and SBTX procedure is technically feasible and clinically useful in overcoming the challenges associated with size mismatched SBTX. Our short-term findings justify further investigation in a larger series to elucidate the long-term outcomes of this procedure.
由于大小不匹配，儿童接受成人较大移植物的小肠移植（SBTX）可能具有挑战性。本研究旨在评估同时进行连续横向肠成形术（STEP）是否可以解决大小不匹配的问题。
在 14 天随访的猪模型中，比较了供体和受体之间的三种不同大小比例组。这些组分别为大小匹配组、大小不匹配组（1:3.8 体重比）和大小不匹配+STEP 组（每组 n=8）。
同时进行 STEP 和不匹配肠段的 SBTX 在技术上是可行的。术后临床过程平稳。在再次剖腹探查时，未观察到出血、渗漏、狭窄或肠梗阻的迹象，且肠段血供良好。所有组的体重均下降，但大小不匹配+STEP 组的下降百分比最低。所有组的重要肠细胞质量相似（瓜氨酸水平），且 STEP 组的营养状况最佳（转铁蛋白水平，p=0.04）。
我们已经证明，同时进行 STEP 和 SBTX 手术在技术上是可行的，并且在克服与大小不匹配的 SBTX 相关的挑战方面具有临床实用性。我们的短期研究结果证明了进一步在更大系列中进行研究以阐明该手术的长期结果是合理的。
