Pollard Stephen
Department of Transplantation, St. James University Hospital, Leeds, United Kingdom.
Clin Colon Rectal Surg. 2004 May;17(2):119-24. doi: 10.1055/s-2004-828658.
Intestinal transplantation is gradually becoming a therapeutic intervention rather than an experimental procedure. In the long term, the best outcome for patients with intestinal failure remains total parenteral nutrition, but where this is unlikely to allow long-term survival because of loss of venous access sites or severe cholestasis, intestinal transplantation should be considered. The technical aspects of the procedure are well described and advances in recent years in both immunosuppression and antimicrobial therapy have led to improved outcomes, particularly in the larger centers. Graft monitoring and the profound sepsis that accompanies graft dysfunction due to bacterial translocation remain major challenges, whereas the issues of denervation, lymphatic disruption, graft-versus-host disease (GVHD), and nonphysiological venous drainage have not proved to be major problems. Whether intestinal transplantation will become an alternative for the stable patient on total parenteral nutrition rather than a salvage procedure for when total parenteral nutrition fails remains to be seen.
肠道移植正逐渐成为一种治疗手段而非实验性手术。从长远来看，肠衰竭患者的最佳结局仍是全胃肠外营养，但如果因静脉通路丧失或严重胆汁淤积而无法长期存活，则应考虑肠道移植。该手术的技术细节已有详细描述，近年来免疫抑制和抗菌治疗的进展使治疗效果得到改善，尤其是在较大的中心。移植物监测以及因细菌移位导致移植物功能障碍所伴随的严重脓毒症仍然是主要挑战，而去神经化、淋巴系统破坏、移植物抗宿主病（GVHD）和非生理性静脉引流等问题尚未被证明是主要问题。肠道移植能否成为接受全胃肠外营养稳定患者的替代选择，而非全胃肠外营养失败时的挽救性手术，仍有待观察。
