Ⅱ型肠衰竭患者的临床诊疗及其结局分析  

Clinical characteristics,treatment strategy,and clinical outcomes in type 2 intestinal failure

作　　者：葛晓龙 戚卫林 刘威[1] 徐海利[1] 叶玲娜[2] 曹倩[2] 李宁 周伟[1] Ge Xiaolong;Qi Weilin;Liu Wei;Xu Haili;Ye Linna;Cao Qian;Li Ning;Zhou Wei(Department of General Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310016,China;Department of Gastroenterology,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310016,China;Department of Colorectal Disease,Shanghai Tenth People's Hospital,Tongji University School of Medicine,Shanghai 200072,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院普通外科,杭州310016 [2]浙江大学医学院附属邵逸夫医院消化内科,杭州310016 [3]上海市第十人民医院结直肠病科,上海200072

出　　处：《中华胃肠外科杂志》2024年第9期966-969,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82370550)。

摘　　要：目的分析Ⅱ型肠衰竭的疾病特征、诊治策略及临床结局。方法采用描述性病例系列研究方法。病例入选标准:(1)符合欧洲临床营养与代谢协会(ESPEN)肠衰竭的诊断定义;(2)连续肠外营养治疗时间>28 d;(3)接受由外科医生、临床营养师、药剂师、造口伤口护理师和重症监护病房医生组成的多学科诊疗团队(MDT)的诊疗;(4)临床资料完整。排除Ⅰ型或Ⅲ型肠衰竭及随访不配合者。浙江大学医学院附属邵逸夫医院普通外科2016年1月至2023年12月期间收治的67例Ⅱ型肠衰竭患者的临床资料纳入分析。主要分析本组Ⅱ型肠衰竭患者的病因并进行病理生理分类,分析治疗转归情况。结果67例患者中,男性43例,女性24例;中位年龄54(15~83)岁;体质指数(17.5±3.8)kg/m^(2),营养不良发生率67.2%(45/67),肌少症发生率74.6%(50/67),既往腹部手术中位次数2.0(1~13)次,接受肠外营养治疗中位时间为2.1(1~12)个月。初始疾病包括克罗恩病36例,溃疡性结肠炎2例,放射性肠炎3例、肠白塞病2例,肠系膜血管性病变4例,侵袭性纤维瘤病1例,腹茧症5例,消化道穿孔5例,肠内疝1例,肠动力障碍4例,其他原因(胃肠道肿瘤、外伤及非霍奇金淋巴瘤)4例。根据肠衰竭病理生理分类,肠瘘33例,肠动力障碍12例,机械性肠梗阻6例,短肠13例,广泛小肠黏膜病变3例。经MDT模式诊治后,67例Ⅱ型肠衰竭患者均接受了联合营养支持治疗方案的肠康复治疗,其中36例患者恢复口服饮食或肠内营养;31例患者经过肠康复治疗后效果不佳,最终接受确定性手术,确定性手术距肠康复治疗的间隔中位时间2.7(1~9)个月。术后24例患者恢复肠道自主功能,7例死亡,其中6例死因为腹腔感染,1例为肠动力障碍致营养衰竭和肝功能衰竭。结论多学科综合诊疗有利于Ⅱ型肠衰竭的自主肠道功能的恢复。Objective To evaluate the characteristics,clinical management and clinical outcomes of type 2 intestinal failure(IF).Methods A descriptive case-control study was carried out.The inclusion criteria were as follows:(1)the diagnosis of IF was performed according to the European Society for Parenteral and Enteral Nutrition(ESPEN)consensus statement.(2)using a requirement for parenteral nutrition(PN)of 28 days or more as surrogate marker.(3)a multidisciplinary team(MDT)included surgeons,nutritionist,pharmacist,stoma therapists,andcritical care physicians.(4)complete laboratory data.Patients with type 1 and type 3 IF and those who do not cooperate with follow-up.All the data of 67 type II IF were collected from the database in Sir Run Run Shaw Hospital from Jan 2016 to Dec 2023.The pathophysiology,clinical management,and outcomes of type II IF were analyzed.Results A total of 67 type II IF were included.The median age was 54(15-83)with 43 males and 24 females.The body mass index was(17.5±3.8)kg/m^(2),the incidence of malnutrition was 67.2%(45/67),the incidence of sarcopenia was 74.6%(50/67),the median number of previous surgeries was 2.0(1-13),and the median duration time of PN was 2.1(1-12)months.The underlying disease of type 2 IF included 36 Crohn`s disease,2 ulcerative colitis,3 radiation enteritis,2 intestinal Behcet's disease,4 mesenteric infarction,1 aggressive fibromatosis,5 abdominal cocoon syndrome,5 gastrointestinal perforation,1 hernia,4 intestinal dysmotility,and 4 other reasons(gastrointestinal tumor,trauma,and non-Hodgkin's lymphoma).According to the pathophysiology of IF,there were 33 intestinal fistula,12 intestinal dysmotility,6 mechanical obstruction,13 short bowel syndrome,and 3 extensive small bowel mucosal disease.After treatment with MDT,67 patients with type 2 IF received nutritional support therapy for intestinal rehabilitation treatment,of which 36 patients recovered with oral diet or enteral nutrition,31 patients underwent reconstructive surgery after intestinal rehabilitation treatment fail

关 键 词：肠衰竭 Ⅱ型 病因 多学科综合诊疗 肠康复 

分 类 号：R574[医药卫生—消化系统]