Thompson Jon S, DiBaise John K, Iyer Kishore R, Yeats Melania, Sudan Debra L
Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, USA.
J Am Coll Surg. 2005 Jul;201(1):85-9. doi: 10.1016/j.jamcollsurg.2005.02.034.
Unanticipated massive resection after intraabdominal procedures is an increasing cause of short bowel syndrome (SBS). Our aim was to determine the frequency and potential mechanisms of postoperative SBS.
We reviewed retrospectively the clinical course of 210 adult patients with SBS evaluated over a 20-year period.
Fifty-two (25%) patients had postoperative SBS. The initial operations included colectomy (n=20), hysterectomy (n=8), appendectomy (n=5), gastric bypass (n=5), and other (n=14). Intestinal obstruction (n=38) was the most common reason for resection leading to SBS, either from adhesions (n=26) or volvulus (n=12). Postoperative intestinal ischemia led to resection in 14 patients. SBS occurred from 1 day postoperatively to years later, with 16 (30%) intestinal resections occurring within 1 month. Patients undergoing resection for intestinal ischemia were more likely to undergo resection during the first month than were patients with adhesions and volvulus (86% versus 4% and 25%,respectively, p < 0.05): Patients undergoing resection for ischemia and volvulus were more likely to have remnant length<60 cm compared with those with adhesions (57% and 58% versus 23%, respectively, p < 0.05). Patients undergoing resection for adhesive obstruction were more likely to undergo multiple resections. Thirty-five (67%) patients required longterm parenteral nutrition. Seven (13%) patients died, three in the early postoperative period and four from complications of SBS.
SBS is a potential postoperative complication of intraabdominal procedures and accounts for a considerable proportion of tertiary referrals for SBS. Surgical treatment of postoperative obstruction after common surgical procedures is the most frequent cause. Preventing adhesions, avoiding technical errors, diagnosing a potentially ischemic intestine in a timely manner, and approaching the frozen abdomen cautiously are important strategies for preventing this condition.
腹部手术后意外的大面积肠切除是短肠综合征（SBS）日益增多的原因。我们的目的是确定术后SBS的发生率及潜在机制。
我们回顾性分析了210例成年SBS患者在20年期间的临床病程。
52例（25%）患者发生术后SBS。初始手术包括结肠切除术（n = 20）、子宫切除术（n = 8）、阑尾切除术（n = 5）、胃旁路手术（n = 5）以及其他手术（n = 14）。肠梗阻（n = 38）是导致SBS的最常见切除原因，其中粘连性肠梗阻（n = 26）或肠扭转（n = 12）。术后肠缺血导致14例患者进行肠切除。SBS发生于术后1天至数年之后，16例（30%）肠切除发生在1个月内。因肠缺血接受肠切除的患者比因粘连和肠扭转接受肠切除的患者更有可能在第一个月内进行肠切除（分别为86%对4%和25%，p < 0.05）：因缺血和肠扭转接受肠切除的患者与因粘连接受肠切除的患者相比，更有可能剩余肠段长度<60 cm（分别为57%和58%对23%，p < 0.05）。因粘连性肠梗阻接受肠切除的患者更有可能接受多次肠切除。35例（67%）患者需要长期肠外营养。7例（13%）患者死亡，3例死于术后早期，4例死于SBS并发症。
SBS是腹部手术后潜在的并发症，在SBS三级转诊中占相当大的比例。常见外科手术后对术后梗阻的外科治疗是最常见的原因。预防粘连、避免技术失误、及时诊断潜在的缺血肠段以及谨慎处理冰冻骨盆是预防这种情况的重要策略。
