短肠综合征患儿的长期胃肠外营养支持和肠道适应性的改变:25年临床经验回顾  

Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: A 25 - year experi- ence

作　　者：Quirós-Tejeira R.E. Ament M.E. Reyen L. 李开 

机构地区：[1]Div.of Gastroenterol.and NutritionUCLA Medical Center,Los Angeles,California [2]Sect.P.,Houston,TX,United States

出　　处：《世界核心医学期刊文摘（儿科学分册）》2005年第1期39-39,共1页

摘　　要：目的:对于短肠综合征(SBS)患儿长期接受胃肠外营养(PN)后的愈复状况进行分析。方法:搜集1975- 2000年间的短肠综合征病例,其中78例患儿接受胃肠外营养3个月以上,对其病例资料进行回顾性分析。统计分析:采用单变量分析,Kaplan-Meier法和Cox比例回归模型。结果:确诊了78例患者。患者具备如下情况时,其存活状况较好:小肠长度(SBL)大于38 cm。Objective To analyze the outcome of children with short bowel syndrome (SBS) who required long-term parenteral nutrition (PN) . Study design Retrospective analysis of children (n =78) - with SBS who required PN > 3 months from 1975 to 2000. Statistics: univariate analysis, Kaplan-Meier method, and Cox proportional regression mod-elwere used. Results We identified 78 patients. Survival was better with small bowel length (SBL) - > 38 cm, intact ileocecal valve (ICV), intact colon, takedown surgery after ostomy (all P < . 01), and primary anastomosis (P < . 001) . PN-associated early persistent cholestatic jaundice (P < . 001) and SBL of <15cm (P < . 01) were associated with a higher mortality. Intestinal adaptation was less likely if SBL <15 cm (P < . 05), ICV was removed, colonic resection was done (both P < . 001), > 50% of colon was resected (P < . 05), and primary anastomosis could not be accomplished (P<.01) . Survival was 73% (57), and 77% (44) of survivors had intestinal adaptation. Conclusions SBL, intact ICV, intestinal continuity, and preservation of the colon are important factors for survival and adaptation. Adaptation usually occurred within the first 3 years. Need for long-term PN does not preclude achieving productive adulthood. Patients with ICV even with < 15 cm of SBL and patients with SBL > 15 cm without ICV have a chance of intestinal adaptation.

关 键 词：胃肠外营养支持 短肠综合征 存活状况 肠切除手术 单变量分析 回归模型 适应性改变 统计分析 肠吻合术 结肠切除 

分 类 号：R459.3[医药卫生—治疗学]