Ecker K W, Hildebrandt U, Haberer M, Feifel G
Department of General, Abdominal and Vascular Surgery, University of Saarland, Homburg/Saar, Germany.
Br J Surg. 1996 Nov;83(11):1582-5. doi: 10.1002/bjs.1800831130.
Despite stapler stabilization, sliding complication of nipple valve function occur in 19 per cent of continent ileostomies. Because the tendency of the ileum to desuscept is triggered by traction forces on the mesentery of the nipple during filling of the reservoir, a technique was developed to neutralize this biomechanical strain. In addition, to obtain fibrous healing between the muscular layers, the mucosa of contacting intestinal walls was removed by selective ultrasonic fragmentation. The valves of 18 consecutive patients were operated on with this technique. In six of these, a sliding valve was restabilized in a median time of 1.2 (range 0.4-2.9) years after conventional construction of the pouch. All are functioning well after a median of 4.6 (range 3.0-6.0) years. Between 1.8 and 4.8 years after operation a healed area between the musculature of the nipple and pouch of 4.5-7.2 cm2 was shown by endosonography. This procedure may provide long-term prevention of sliding complications in continent ileostomies.
尽管使用了吻合器进行固定，但在可控性回肠造口术中，乳头瓣功能的滑动并发症发生率仍为19%。由于在贮袋充盈过程中，乳头系膜上的牵引力会引发回肠去敏感化的趋势，因此开发了一种技术来抵消这种生物力学应变。此外，为了实现肌层之间的纤维愈合，通过选择性超声破碎去除了接触肠壁的黏膜。连续18例患者的瓣膜采用该技术进行手术。其中6例患者在传统造袋术后中位时间1.2年（范围0.4 - 2.9年）时，滑动瓣重新稳定。在中位时间4.6年（范围3.0 - 6.0年）后，所有患者功能良好。术后1.8至4.8年，内镜超声显示乳头和贮袋肌肉组织之间的愈合面积为4.5 - 7.2平方厘米。该手术可能为可控性回肠造口术的滑动并发症提供长期预防。
