Bakonyi Neto A, Takegawa B, Ortolan E, Galvão F, Mendonça F, Sbragia L, Crepaldi N, Vicente Y, Chaves H, Guimarães J
Department of Surgery, Botucatu Faculty of Medicine, UNESP, São Paulo, Brazil.
Transplant Proc. 2004 Mar;36(2):259-60. doi: 10.1016/j.transproceed.2004.01.110.
Despite improvements in small bowel transplantation (SBTx), early referral of patients with irreversible intestinal failure (IF) remains a major obstacle. In this study we evaluated the demand for SBTx among seven surgical pediatric centers located at least 200 km from our center.
From 1997 to 2001, 640 patients have been treated for neonatal diseases, including 248 who underwent a minor or major intestinal resection. Twenty-four patients with major resections presented with short gut syndrome, requiring total parenteral nutrition (TPN). The greatest demand was in postsurgical neonates with necrotizing enterocolitis, gastroschiesis, onphalocoeles, or midgut volvulus, and in three adults with postradiotherapy arteritis (n = 2) and mesenteric vein thromboses (n = 1). The median length of residual bowel after resection was 20 to 30 cm, without an ileocecal valve. Four patients were referred for SBTx evaluation; three died while awaiting a donor; 20 were not referred, among whom 14 died of TPN complications.
Approximately 62 children per year require nutritional support for IF, most of whom develop complications related to TPN. Because many patients who are TPN-dependent develop complications, we believe that early referral would reduce mortality.
Greater medical awareness about the feasibility of SBTx procedures and earlier referral may improve results and quality of life after transplant.
尽管小肠移植（SBTx）有所改进，但不可逆肠衰竭（IF）患者的早期转诊仍然是一个主要障碍。在本研究中，我们评估了距离我们中心至少200公里的七个小儿外科中心对SBTx的需求。
1997年至2001年，640例患者接受了新生儿疾病治疗，其中248例接受了小肠大或小切除术。24例接受大切除术的患者出现短肠综合征，需要全胃肠外营养（TPN）。需求最大的是患有坏死性小肠结肠炎、腹裂、脐膨出或中肠扭转的术后新生儿，以及三名患有放疗后动脉炎（n = 2）和肠系膜静脉血栓形成（n = 1）的成人。切除术后残余肠管的中位长度为20至30厘米，无回盲瓣。4例患者被转诊进行SBTx评估；3例在等待供体时死亡；20例未被转诊，其中14例死于TPN并发症。
每年约有62名儿童需要IF的营养支持，其中大多数出现与TPN相关的并发症。由于许多依赖TPN的患者会出现并发症，我们认为早期转诊可以降低死亡率。
提高对SBTx手术可行性的医学认识并更早转诊可能会改善移植后的结果和生活质量。
