Pezim M E, Johnson H W, Gillespie K D, Willard P, Owen D A
Department of Surgery, University of British Columbia, Vancouver, Canada.
Dis Colon Rectum. 1993 Jan;36(1):16-22. doi: 10.1007/BF02050296.
The aim of this study was to develop a natural tissue valve that could be anastomosed into any area of the gastrointestinal (GI) tract to act as a fecal "brake" and so establish enteric continence at that site. A 4-cm-long valve created from an intussuscepted small bowel pedicle was anastomosed into the cecum and brought out through the abdominal wall as a stoma in 11 rabbits. The animals were re-explored five weeks later for assessment of valve viability and continence and microscopic appearance. In all cases, the valve was fully continent in vivo. All valves were viable, and there was no anastomotic leakage. Pressure testing of the valve at reoperation revealed that 7 of 10 valves tested withstood pressures of 30 mmHg before and after catheterization and 6 of 10 were fully continent to cecal "blanching" pressure (50 mmHg). Valve failure was due to deintussusception in three cases. In four cases, valves were continent over 50 mmHg and showed no tendency to incontinence to bursting pressure of the cecum. We conclude that a continent pedicle valve unit (PVU) for placement in a variety of locations in the GI tract is feasible. The PVU has implications in the management of short-gut syndrome, incontinent ileostomy, continent cecostomy, and as a continent valve placed in the perineum for restoration of perineal defecation following proctectomy.
本研究的目的是开发一种天然组织瓣膜，该瓣膜可吻合到胃肠道（GI）的任何区域，充当粪便“制动器”，从而在该部位建立肠道节制。将由套叠小肠蒂制成的4厘米长瓣膜吻合到11只兔子的盲肠中，并通过腹壁引出作为造口。五周后对动物进行再次探查，以评估瓣膜的活力、节制功能和微观外观。在所有情况下，瓣膜在体内均完全具有节制功能。所有瓣膜均存活，且无吻合口漏。再次手术时对瓣膜进行压力测试发现，10个测试瓣膜中有7个在插管前后能承受30 mmHg的压力，10个中有6个对盲肠“变白”压力（50 mmHg）完全具有节制功能。3例瓣膜功能失败是由于套叠复位。4例中，瓣膜在超过50 mmHg时具有节制功能，且对盲肠破裂压力无失禁倾向。我们得出结论，用于放置在胃肠道不同位置的可控带蒂瓣膜单元（PVU）是可行的。PVU在短肠综合征、无节制回肠造口术、可控盲肠造口术的管理中具有意义，并且可作为放置在会阴部的可控瓣膜用于直肠切除术后恢复会阴部排便。
