Encinas J L, Luis A, Avila L F, Hernandez F, Sarria J, Gamez M, Murcia J, Leal L, Lopez-Santamaria M, Tovar J A
Department of Pediatric Surgery Service, Hospital Universitario La Paz, Madrid, Spain.
Eur J Pediatr Surg. 2006 Dec;16(6):403-6. doi: 10.1055/s-2006-924735.
The management of children receiving small bowel grafts involves potentially life-threatening complications that affect their nutritional status. The aim of this paper was to define these factors and their influence on nutritional outcome.
Patients with intestinal failure (IF) who received an isolated small bowel transplantation (SBT) or small bowel/liver transplantation (SBLT) at our hospital during the last 6 years were reviewed for weight Z-score, biochemical nutritional parameters, total parenteral nutrition (TPN) weaning, catheter-related sepsis, rejection and steroid treatment.
Twenty patients, 11 females and 9 males, received a SBT or a SBLT and survived the postoperative period; in the present study we only included 11 children with follow-up periods longer than 1 year. Seven males and 4 females with a mean age of 4.5 years (range, 1 to 20 years) received 6 SBLT and 5 SBT. Nine (82%) were weaned from TPN to an amino-acid or peptide enteral formula during the first 6 months after surgery. During the first year there was a significant increase in total protein from 5.11 +/- 1.8 mg/dl to 6.1 +/- 1.5 mg/dl (p < 0.05) and an increase in albumin from 3.8 +/- 0.9 mg/dl to 4.5 +/- 1.1 mg/dl (p < 0.05). There was an increase in weight Z-score in 9 patients (82%) during the first year. Mean Z-score improved from - 2.6 +/- 1 at transplant to - 1.0 +/- 0.6 (p < 0.05) after 1 year. Three patients (27.2%) had at least one rejection period, which was treated with steroids alone or in combination. Mean weight Z-score 1 year after surgery was - 0.9 +/- 0.6 for patients without rejection and - 1.24 +/- 0.8 for those with at least one rejection episode treated with steroids (p > 0.1). Four patients (36%) had at least one catheter-related sepsis episode. Mean weight Z-score 1 year after surgery was - 1.01 +/- 0.6 for patients without catheter-related sepsis and - 1.24 +/- 0.8 for those with at least one catheter-related sepsis episode (p > 0.1).
There was a significant improvement in weight Z-score and biochemical nutritional parameters 1 year after receiving a small bowel graft. No influence of steroids or catheter-related sepsis on children's nutritional status was noted 1 year after surgery, although this point will need further evaluation.
接受小肠移植的儿童管理涉及可能危及生命的并发症，这些并发症会影响他们的营养状况。本文旨在确定这些因素及其对营养结局的影响。
回顾了过去6年在我院接受孤立小肠移植（SBT）或小肠/肝脏移植（SBLT）的肠衰竭（IF）患者的体重Z评分、生化营养参数、全胃肠外营养（TPN）撤减、导管相关败血症、排斥反应和类固醇治疗情况。
20例患者，11例女性和9例男性，接受了SBT或SBLT并存活至术后；在本研究中，我们仅纳入了11例随访期超过1年的儿童。7例男性和4例女性，平均年龄4.5岁（范围1至20岁），接受了6例SBLT和5例SBT。9例（82%）在术后前6个月内从TPN撤减至氨基酸或肽类肠内营养配方。在第一年，总蛋白从5.11±1.8mg/dl显著增加至6.1±1.5mg/dl（p<0.05），白蛋白从3.8±0.9mg/dl增加至4.5±1.1mg/dl（p<0.05）。9例患者（82%）在第一年体重Z评分增加。平均Z评分从移植时的-2.6±1改善至1年后的-1.0±0.6（p<0.05）。3例患者（27.2%）至少经历过一次排斥期，采用单独或联合类固醇治疗。无排斥反应患者术后1年的平均体重Z评分为-0.9±0.6，至少经历过一次类固醇治疗的排斥发作患者为-1.24±0.8（p>0.1）。4例患者（36%）至少经历过一次导管相关败血症发作。无导管相关败血症患者术后1年的平均体重Z评分为-1.01±0.6，至少经历过一次导管相关败血症发作患者为-1.24±0.8（p>0.1）。
接受小肠移植1年后，体重Z评分和生化营养参数有显著改善。术后1年未发现类固醇或导管相关败血症对儿童营养状况有影响，尽管这一点需要进一步评估。
