Lloyd D A
Prog Pediatr Surg. 1978;12:51-106.
Most patients who undergo massive small bowel resection develop the "short bowel syndrome", which usually resolves as intestinal adaptation takes place. Some, in whom adaptation appears to be inadequate, remain severely incapacitated, and attempts have been made to improve absorption using a variety of surgical maneuvers. Successes have been recorded, but the procedures (of which reversal of a segment of small intestine to prolong the intestinal transit time has been most frequently used) are unpredictable and may actually be harmful. This study was designed to evaluate the theory that, because of the slow pattern of peristaltic activity inherent in the colon, the intestinal transit time could be safely and predictably prolonged after massive small bowel resection by transposing a segment of colon to between the jejunal and ileal remnants in an iso-peristaltic direction. The following procedures were performed, using 56 rats: (1) Resection of 80% or 90% of the small intestine. (2) Small bowel resection (80% or 90%) and iso-peristaltic jejuno-ileal colonic interposition. (3) Bowel anastomoses without resection. Intestinal function was subsequently evaluated by studying the following: (1) body weight; (2) blood count; (3) intestinal transit time (by contrast radiography); (4) intestinal absorption of sodium iodide, albumin, triolein and Vitamin B12 (using radioisotopic methods); (5) intestinal morphology. Colonic interposition did not have any significant effect following 80% small bowel resection. After 90% resection, colonic interposition increased the intestinal transit time significantly (p less than 0.001) without mortality or serious morbidity, and did not cause intestinal obstruction or prevent intestinal adaptation. Body weight and intestinal absorption were not increased significantly, but the study was too short to exclude an eventual beneficial effect in terms of body weight. It was concluded that iso-peristaltic colonic interposition is a safe and reliable method of prolonging the intestinal transit time after massive small bowel resection in the rat, thereby increasing the efficiency of absorption within the existing absorption capacity. The procedure has been found to be beneficial in dogs, and for reasons discussed, should be equally effective in man. Adjunctive surgery is not recommended at the time of resection in man, but should be considered if absorption remains severely impaired.
大多数接受大量小肠切除手术的患者会出现“短肠综合征”，随着肠道适应性的发生，这种综合征通常会得到缓解。有些患者的适应性似乎不足，仍然严重丧失能力，人们尝试通过各种手术操作来改善吸收功能。虽然有成功的记录，但这些手术（其中最常用的是将一段小肠翻转以延长肠道运输时间）不可预测，实际上可能有害。本研究旨在评估这样一种理论，即由于结肠固有的蠕动活动模式缓慢，通过将一段结肠以等蠕动方向移植到空肠和回肠残端之间，在大量小肠切除术后可以安全且可预测地延长肠道运输时间。使用56只大鼠进行了以下手术：（1）切除80%或90%的小肠。（2）小肠切除（80%或90%）并进行等蠕动空肠-回肠结肠间置术。（3）不进行切除的肠吻合术。随后通过研究以下方面评估肠道功能：（1）体重；（2）血细胞计数；（3）肠道运输时间（通过对比造影）；（4）碘化钠、白蛋白、三油酸甘油酯和维生素B12的肠道吸收（使用放射性同位素方法）；（5）肠道形态。80%小肠切除术后结肠间置术没有任何显著效果。90%切除术后，结肠间置术显著增加了肠道运输时间（p小于0.001），没有死亡或严重并发症，也没有导致肠梗阻或妨碍肠道适应。体重和肠道吸收没有显著增加，但研究时间太短，无法排除最终对体重的有益影响。得出的结论是，等蠕动结肠间置术是一种安全可靠的方法，可延长大鼠大量小肠切除术后的肠道运输时间，从而在现有吸收能力范围内提高吸收效率。该手术在狗身上已被证明是有益的，并且基于所讨论的原因，在人类中应该同样有效。在人类切除时不建议进行辅助手术，但如果吸收仍然严重受损，则应考虑。
