Saday C, Mir E
Department of Pediatric Surgery, Behçet Uz Children Hospital, Izmir, Turkey.
J Surg Res. 1996 May;62(2):184-91. doi: 10.1006/jsre.1996.0193.
Despite numerous investigations short bowel syndrome (SBS) is still an unsolved clinical problem. The purpose of this study was to develop a new surgical approach that combines both intestinal lengthening and growing neomucosa. The operative principle is based on a longitudinal division of an intestinal segment antimesenterically and a formation of two intestinal tubes out of bowel halves anastomosing one cutting edge to the incised mucosal midline and the other to the antimesenteric side of the constructed first intestinal tube, so that a common wall between the two hemiloops was created which leads to grow neomucosa. This procedure was applied to 11 rabbits. The hemiloops and neomucosa were investigated for its feasibility and morphologic characteristics. Gross and microscopic examinations at 8 weeks revealed that all the intestinal tubes were viable and patent. No anastomotic leakage was present. In all animals, the serosal surfaces of the common walls were covered with neomucosa that resembles the mucosa of the existing intestine morphologically; there was no significant difference in villus height, villus width at base, crypt depth, number of villi per unit serosal length, villus surface, and villus surface per unit serosa. The growth of neomucosa was completely a result of epithelialization without any evidence of contraction. The quantity and rate of neomucosal growth seems unaffected by intestinal segment length. Finally a two times increase in intestinal length, whereas the diameter halved and a statistically significant increase (P < 0.001) in total villus surface via growing neomucosa was obtained. This model might be useful in the management of SBS when supported by clinical and functional investigations.
尽管进行了大量研究，但短肠综合征（SBS）仍是一个尚未解决的临床问题。本研究的目的是开发一种新的手术方法，该方法结合了肠管延长和新黏膜生长。手术原理基于对肠段进行肠系膜对侧的纵向分割，并由肠管的两半形成两个肠管，将一个切缘与切开的黏膜中线吻合，另一个与构建的第一个肠管的肠系膜对侧吻合，从而在两个半环之间形成一个共同壁，导致新黏膜生长。该手术应用于11只兔子。对半环和新黏膜进行了可行性和形态学特征研究。8周时的大体和显微镜检查显示，所有肠管均存活且通畅。无吻合口漏。在所有动物中，共同壁的浆膜表面覆盖有形态上类似于现存肠道黏膜的新黏膜；绒毛高度、基部绒毛宽度、隐窝深度、单位浆膜长度的绒毛数量、绒毛表面积和单位浆膜的绒毛表面积均无显著差异。新黏膜的生长完全是上皮化生的结果，没有任何收缩迹象。新黏膜生长的数量和速度似乎不受肠段长度的影响。最终，肠管长度增加了两倍，而直径减半，并且通过新黏膜生长使总绒毛表面积有统计学意义的增加（P < 0.001）。当得到临床和功能研究支持时，该模型可能对短肠综合征的治疗有用。
