Sudan Debra, Thompson Jon, Botha Jean, Grant Wendy, Antonson Dean, Raynor Steve, Langnas Alan
Department of Surgery, Nebraska Medical Center, Omaha, Nebraska 68198-3285, USA.
Ann Surg. 2007 Oct;246(4):593-601; discussion 601-4. doi: 10.1097/SLA.0b013e318155aa0c.
Review the clinical results of 24 years of intestinal lengthening procedures at one institution.
Retrospective review of a single center experience comparing the outcome of 2 intestinal lengthening procedures (Bianchi and serial transverse enteroplasty [STEP]) in terms of survival, total parenteral nutrition (TPN) weaning, and complications.
Sixty-four patients, including 14 adults, underwent 43 Bianchi and 34 STEP procedures between 1982 and 2007. Three patients had prior isolated liver transplants. The median (range) remnant bowel length before first lengthening was 45 (11-150) cm overall; (Bianchi=44 cm, STEP=45 cm) and 68 (20-250) cm after lengthening; (Bianchi=68 cm, STEP=65 cm). Actual survival is 91% overall (Bianchi 88%, STEP 95%) with median follow-up of 3.8 years (Bianchi=5.9 years, STEP=1.7 years). Average enteral caloric intake in pediatric patients was 15 kcal/kg before lengthening and 85 kcal/kg at 1 year after lengthening. Sixty-nine percent of patients are off TPN at most recent follow-up, including 8 who were weaned from TPN after intestinal transplantation. Liver disease (when present) was reversed in 80%. Surgical complications occurred in 10%, more commonly requiring reoperation after Bianchi than STEP. Intestinal transplantation salvage was required in 14% at a median of 2.9 years (range=8 months to 20.7 years) after lengthening.
Surgical lengthening with both Bianchi and STEP procedures results in improvement in enteral nutrition, reverses complications of TPN and avoids intestinal transplantation in the majority with few surgical complications. Intestinal transplantation can salvage most patients who later develop life-threatening complications or fail to wean TPN.
回顾某机构24年肠道延长手术的临床结果。
对单中心经验进行回顾性分析，比较两种肠道延长手术（比安基手术和系列横断肠成形术[STEP]）在生存率、全胃肠外营养（TPN）撤机及并发症方面的结果。
1982年至2007年间，64例患者（包括14例成人）接受了43例比安基手术和34例STEP手术。3例患者曾接受过单独的肝移植。首次延长术前残余肠管长度中位数（范围）总体为45（11 - 150）cm；（比安基手术=44 cm，STEP=45 cm），延长术后为68（20 - 250）cm；（比安基手术=68 cm，STEP=65 cm）。总体实际生存率为91%（比安基手术88%，STEP 95%），中位随访时间为3.8年（比安基手术=5.9年，STEP=1.7年）。儿科患者延长术前肠内热量摄入平均为15 kcal/kg，延长术后1年为85 kcal/kg。在最近一次随访时，69%的患者停用了TPN，其中8例在肠移植后停用了TPN。80%的肝病患者（若存在）病情得到逆转。手术并发症发生率为10%，比安基手术后比STEP更常需要再次手术。延长术后中位2.9年（范围=8个月至20.7年），14%的患者需要进行肠移植挽救。
比安基手术和STEP手术进行的手术延长可改善肠内营养，逆转TPN并发症，多数患者可避免肠移植，且手术并发症少。肠移植可挽救大多数后来出现危及生命并发症或无法停用TPN的患者。
