The feasibility of using an endoluminal device for intestinal lengthening
The feasibility of using an endoluminal device for intestinal lengthening
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DOI：
10.1016/j.jpedsurg.2010.03.015
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发表时间：
2010-08-01
影响因子：
2.4
通讯作者：
Dunn, James C. Y.
中科院分区：
文献类型：
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作者：
Shekherdimian, Shant;Panduranga, Mohanchandra K.;Dunn, James C. Y.
目的：先前的研究表明，使用机械力延长肠段的能力需要配备体外装置。本研究评价了一种完全可植入的装置用于活体小肠延长的可行性。方法：用可吸收缝线将生物相容的5倍扩张的镍钛合金弹簧加压，植入大鼠空肠近端的分离节段内。用不可吸收缝线加压的弹簧作为对照。用连续的腹部X光观察这些动物，直到弹簧完全扩张。然后取出肠段进行组织学分析。结果：实验组肠段长度由1.3+/-0.3 cm延长至4.4+/-0.5 cm(P<；.001)。术后36天(16~50天)达到最大弹簧长度。在对照组，肠道长度也有增加，从1.6+/-0.04厘米增加到2.9+/-0.4厘米(P<；.001)(图4)。在百分比上，试验组的长度增加了250%，而对照组增加了85%(P<；.001)。对对照肠段和实验肠段的显微镜评估显示，肠道结构大体保持不变，但肌层肥大和绒毛萎缩。结论：在动物模型中，可植入弹簧的持续机械力成功地延长了离体肠段。虽然类似的结果已经在其他设备上得到证实，但目前的设备是完全可植入的，并且可以通过内窥镜进行部署。(C)2010 Elsevier Inc.保留所有权利。
Purpose: Prior studies demonstrating the ability to lengthen intestinal segments with mechanical force required devices with extracorporeal components. The feasibility of using a completely implantable device for in vivo intestinal lengthening was evaluated in this study.Methods: Biocompatible Nitinol springs capable of 5-fold expansions were compressed using absorbable sutures and were implanted into isolated segments of proximal jejunum in rats. Springs compressed with nonabsorbable sutures served as controls. The animals were observed with serial abdominal x-rays until the springs became fully expanded. Intestinal segments were then retrieved for histologic analysis. Two-tailed and paired Student's t tests were used for statistical analysis.Results: Intestinal segments were successfully lengthened in the experimental group from 1.3 +/- 0.3 cm to 4.4 +/- 0.5 cm (P < .001). Maximum spring length was achieved on postoperative day 36 (range, 16-50 days). In the control group, there was also an increase in intestinal lengths, from 1.6 +/- 0.04 cm to 2.9 +/- 0.4 cm (P < .001) (Fig. 4). In percentages, a 250% increase in length was observed in the experimental group vs an 85% increase in the control group (P < .001). Microscopic evaluation of both control and experimental segments revealed gross preservation of intestinal architecture; however, muscular layer hypertrophy and villous atrophy were noted.Conclusions: Continuous mechanical force with an implantable spring successfully lengthened isolated segments of small bowel in an animal model. Although similar results have been demonstrated using other devices, the current device is totally implantable and may be deployed endoscopically. (C) 2010 Elsevier Inc. All rights reserved.