Zanfi C, Lauro A, Cescon M, Dazzi A, Ercolani G, Grazi G L, Zanello M, Vivarelli M, Del Gaudio M, Ravaioli M, Cucchetti A, Vetrone G, Tuci F, Di Gioia P, Lazzarotto T, D'Errico A, Bagni A, Faenza S, Siniscalchi A, Pironi L, Pinna A D
Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Transplant Proc. 2010 Jan-Feb;42(1):39-41. doi: 10.1016/j.transproceed.2009.12.020.
Surgical approaches to complicated benign intestinal failure are accepted worldwide, especially in the pediatric population. Intestinal transplant surgery is thought to rescue patients in whom complications of total parenteral nutrition (TPN) develop.
To report our experience with surgical intestinal rescue in an adult population with intestinal failure.
An intestinal rehabilitation program initiated at our institution included comprehensive medical rehabilitation, surgical bowel rescue, and transplantation. From 2000 to 2009, of 81 adult patients referred by our gastroenterologists for bowel rehabilitation, 42 (51,8%) underwent 43 transplantations (32 isolated intestinal grafts and 11 multivisceral grafts). Underlying diseases were primarily short-bowel syndrome, Gardner syndrome, and intestinal pseudo-obstruction. Thirty-nine patients (48,2%) underwent surgical rescue (40 cases) consisting of bowel resection, adhesiolysis, stricturoplasty, liver transplantation with portocaval hemitransposition (6 cases in 5 patients). Underlying diseases were primarily intestinal fistulas, stenosis, or perforations, short-bowel syndrome, cocoon syndrome, and complete portal thrombosis.
After a mean (SD) follow-up of 1043 (1016) days, in the transplantation population, 21 patients (50%) are alive, with a 1-, 3-, 5-year patient survival of 76%, 59%, and 52%, respectively, and graft survival of 66%, 54%, and 48%, respectively. After 901 (404) days in the rescue population, 32 patients (82%) are alive (2 died, and 5 were lost to follow-up); in 75%, TPN 25% was discontinued, and are receiving oral feeding with TPN support. The 1- and 3-year survival rate was 100% and 83%, respectively.
Deaths occurred primarily in the transplantation population. Intestinal surgical rescue, when possible, is optimal.
复杂良性肠衰竭的手术治疗方法在全球范围内被广泛接受，尤其是在儿科患者中。肠移植手术被认为可以挽救那些出现全胃肠外营养（TPN）并发症的患者。
报告我们在成年肠衰竭患者中进行手术性肠道挽救的经验。
我们机构启动的肠道康复计划包括全面的医学康复、手术性肠道挽救和移植。2000年至2009年，在我们的胃肠病学家转诊进行肠道康复的81例成年患者中，42例（51.8%）接受了43次移植手术（32例孤立肠移植和11例多脏器移植）。基础疾病主要为短肠综合征、加德纳综合征和肠假性梗阻。39例（48.2%）患者接受了手术挽救（40例次），包括肠切除、粘连松解、狭窄成形术、门静脉半转位的肝移植（5例患者中的6例）。基础疾病主要为肠瘘、狭窄或穿孔、短肠综合征、茧状综合征和完全门静脉血栓形成。
在移植组患者平均（标准差）随访1043（1016）天后，21例（50%）患者存活，1年、3年和5年的患者生存率分别为76%、59%和52%，移植器官生存率分别为66%、54%和48%。在挽救组患者随访901（404）天后，32例（82%）患者存活（2例死亡，5例失访）；75%的患者停用了TPN，25%的患者在TPN支持下接受口服喂养。1年和3年生存率分别为100%和83%。
死亡主要发生在移植组患者中。如有可能，手术性肠道挽救是最佳选择。
