Kimura K, Soper R T
Department of Surgery, University of Iowa College of Medicine, Iowa City.
J Pediatr Surg. 1993 Jun;28(6):792-4. doi: 10.1016/0022-3468(93)90328-i.
For the management of infants with the short-bowel syndrome, we developed a two-stage bowel elongation procedure based on experimental studies of what we term as an isolated bowel segment. The procedure consists of: (1) initial coaptation of the antimesenteric surface of a segment of bowel to host organs such as liver and abdominal wall, and (2) after collaterals have developed from these host organs, secondary longitudinal split of the bowel to provide two bowel loops, one from its antimesenteric half and the other from its mesenteric half. These are arranged in series by end-to-end anastomosis to double the original bowel length. The antimesenteric loop is totally free of its original mesenteric attachment but viable by vascular collaterals formed across the coaptation site. This procedure was successfully used for an infant who was born with 17 cm of duodenum and 17 cm of the distal colon from first trimester intrauterine midgut volvulus. At completion of the multistaged procedures at the age of 1 year when we reentered the abdomen for duodenoplasty, his small bowel measured 90 cm in length. He is currently taking 50% to 60% of required calories via the enteric route at 18 months of age. This procedure is suitable for elongating the duodenum of infants when other alternatives such as the Bianci procedure are not feasible because of mesenteric absence.
对于短肠综合征婴儿的治疗，我们基于对我们所称的孤立肠段的实验研究，开发了一种两阶段的肠延长手术。该手术包括：（1）将一段肠管的系膜对侧表面最初与肝脏和腹壁等宿主器官吻合，以及（2）在这些宿主器官形成侧支循环后，对肠管进行二次纵向劈开，以提供两个肠袢，一个来自其系膜对侧半段，另一个来自其系膜半段。通过端端吻合将它们串联排列，使原始肠管长度加倍。系膜对侧的肠袢完全脱离其原始系膜附着，但通过在吻合部位形成的血管侧支循环保持存活。该手术成功应用于一名因孕早期子宫内中肠扭转出生时十二指肠长17 cm且远端结肠长17 cm的婴儿。在1岁完成多阶段手术后，当我们再次进入腹腔进行十二指肠成形术时，他的小肠长度为90 cm。他目前18个月大，通过肠道途径摄入所需热量的50%至60%。当由于系膜缺失等原因，像比安奇手术等其他替代方法不可行时，该手术适用于延长婴儿的十二指肠。
