Development of an endoluminal intestinal attachment for a clinically applicable distraction enterogenesis device
Development of an endoluminal intestinal attachment for a clinically applicable distraction enterogenesis device
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DOI：
10.1016/j.jpedsurg.2015.10.026
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发表时间：
2016-01-01
影响因子：
2.4
通讯作者：
Teitelbaum, Daniel H.
中科院分区：
文献类型：
--
作者：
Demehri, Farokh R.;Utter, Brent;Teitelbaum, Daniel H.
目的：以前的牵引肠发生方法依赖于盲端肠段或透壁装置固定，需要多次手术并可能造成肠损伤。我们假设使用一种新颖的附件可以使装置可逆地耦合到肠腔表面，从而实现有效的腔内牵引。方法：设计了一种伸缩式液压装置，其带有覆盖有高摩擦网的乳胶球囊附件和扩张的有孔弹性面罩（DFM附件），仅在充气时才允许网与粘膜接触。约克夏猪通过空肠造口术进行了空肠 Roux-en-Y 肢体创建和装置放置。装置每天经历 3 个周期的球囊充气和液压延伸/缩回，持续 7 天，然后移植并研究功效。结果：DFM 附件允许可逆、高强度的腔内耦合，而不会损伤组织或减少肠灌注。植入 7 天后，与进食的非分散肠相比，分散肠的长度增加了 44 +/- 2%，相当于增加了 7.1 +/- 0.3 厘米。与对照肠相比，分散的肠表现出上皮细胞增殖增加。与对照相比，附着部位表现出绒毛变平、隐窝深度增加、粘膜肌层增厚以及固有肌层厚度不变。结论：新型高强度、可逆附着体实现了完全腔内牵张肠发生，实现了与开放手术技术相当的长度增益。这种方法可能有助于开发临床适用的 SBS 治疗技术。 (C) 2016 Elsevier Inc. 保留所有权利。
Purpose: Previous methods of distraction enterogenesis have relied upon blind-ending intestinal segments or transmural device fixation, requiring multiple operations and potential bowel injury. We hypothesized that using a novel attachment would allow reversible device coupling to the luminal bowel surface, achieving effective endoluminal distraction.Methods: A telescopic hydraulic device was designed with latex balloon attachments covered with high-friction mesh and a dilating fenestrated elastic mask (DFM attachment), allowing mesh-to-mucosa contact only with inflation. Yorkshire pigs underwent jejunal Roux-en-Y limb creation and device placement via jejunostomy. Devices underwent 3 cycles of balloon inflation and hydraulic extension/retraction per day for 7 days and then explanted and studied for efficacy.Results: DFM attachment allowed reversible, high-strength endoluminal coupling without tissue injury or reduction in bowel perfusion. After 7 day implant, distracted bowel achieved a 44 +/- 2% increase in length vs. fed, nondistracted bowel, corresponding to a gain of 7.1 +/- 0.3 cm. Distracted bowel demonstrated increased epithelial cell proliferation vs. control bowel. Attachment sites demonstrated villus flattening, increased crypt depth, thicker muscularis mucosa, and unchanged muscularis propria thickness vs. control.Conclusion: Novel high-strength, reversible attachments enabled fully endoluminal distraction enterogenesis, achieving length gains comparable to open surgical techniques. This approach may allow development of clinically applicable technology for SBS treatment. (C) 2016 Elsevier Inc. All rights reserved.