Serial transverse enteroplasty enhances intestinal function in a model of short bowel syndrome
Serial transverse enteroplasty enhances intestinal function in a model of short bowel syndrome
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DOI：
10.1097/01.sla.0000197704.76166.07
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发表时间：
2006-02-01
影响因子：
9
通讯作者：
Jaksic, T
中科院分区：
文献类型：
--
作者：
Chang, RW;Javid, PJ;Jaksic, T
目的/概述 背景资料：连续横向肠成形术（STEP）是一种新的肠道延长手术，已在临床上证明可增加肠道长度。本研究在短肠综合征模型中检测了STEP手术对肠道功能的影响。
方法：幼猪（n = 10）插入一段反向肠段以诱导肠道扩张。5头猪接受90%的肠切除，并对剩余扩张的肠道进行STEP手术，另外5头作为对照，接受90%的肠切除但不进行STEP手术。在切除6周后测定营养状况、吸收能力和细菌过度生长情况。通过两样本t检验进行统计比较（P < 0.05为有显著性差异）。
结果：STEP手术使肠道长度从105.2 ± 7.7厘米增加到152.2 ± 8.3厘米（P < 0.01）。与对照组相比，接受STEP手术的动物体重保持情况更好（平均体重变化为 -0.5% ± 1.8%，对照组为 -17.6% ± 1.5%，P < 0.001）。通过D - 木糖吸收测定的肠道碳水化合物吸收以及通过血清维生素D和甘油三酯水平测定的脂肪吸收能力，STEP组均高于对照组。血清瓜氨酸（肠道黏膜质量的标志物）在接受STEP手术的猪中较对照组显著升高。在近端肠道中，STEP组动物均未出现革兰氏阴性菌过度生长，而对照组5头动物中有4头出现这种情况。
结论：在猪短肠模型中，STEP可改善体重保持、营养状况、肠道吸收能力和血清瓜氨酸水平。还观察到对细菌过度生长有有益影响。这些数据支持在短肠综合征中使用该手术。
Objective/Summary Background Data: Serial transverse enteroplasty (STEP) is a new intestinal lengthening procedure that has been shown to clinically increase bowel length. This study examined the impact of the STEP procedure upon intestinal function in a model of short bowel syndrome.Methods: Young pigs (n = 10) had a reversed segment of bowel interposed to induce bowel dilatation. Five pigs underwent a 90% bowel resection with a STEP procedure on the remaining dilated bowel while 5 served as controls and had a 90% bowel resection without a STEP procedure. Determinations of nutritional status, absorptive capacity, and bacterial overgrowth were conducted 6 weeks after resection. Statistical comparisons were made by 2-sample t test (significance at P < 0.05).Results: The STEP procedure lengthened the bowel from 105.2 +/- 7.7 cm to 152.2 +/- 8.3 cm (P < 0.01). The STEP animals showed improved weight retention compared with controls (mean, -0.5% +/- 1.8% body weight versus -17.6% +/- 1.5%, P < 0.001). Intestinal carbohydrate absorption, as measured by D-Xylose absorption and fat absorptive capacity as measured by serum vitamin D and triglyceride levels, were increased in the STEP group versus controls. Serum citrulline, a marker of intestinal mucosal mass, was significantly elevated in the STEP pigs compared with controls. None of the STEP animals but 4 of 5 control animals were noted to have gram-negative bacterial overgrowth in the proximal bowel.Conclusions: STEP improves weight retention, nutritional status, intestinal absorptive capacity, and serum citrulline levels in a porcine short bowel model. A salutary effect upon bacterial overgrowth was also noted. These data support the use of this operation in short bowel syndrome.