Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.
J Pediatr Gastroenterol Nutr. 2012 Apr;54(4):505-9. doi: 10.1097/MPG.0b013e318230c27e.
Short bowel syndrome poses a great challenge to pediatric teams. Several innovative techniques in the management of total parenteral nutrition (TPN) and bowel reconstructive surgery have improved the outcomes of these children. The authors present their experience during the last decade as a specialist unit using improved techniques and multidisciplinary approaches in the management of this condition.
All of the children presenting with short bowel syndrome between 2000 and 2009 were identified. Diagnosis, length of residual gut, age at definitive surgery, length of gut prelengthening, length of gut postlengthening, TPN status, and survival were recorded. Median values were calculated.
Twenty-seven children were identified (14 boys, 13 girls). Overall survival was 92%. Two children died. Nineteen children required bowel lengthening and 8 children had simple bowel reconstruction while on our protocol. Overall median age at definitive surgery was 12 months. Overall median residual gut length for these was 35.5 cm, whereas the median residual gut length for patients undergoing bowel lengthening was 25 cm. Postbowel lengthening, the median gut length was 90 cm. TPN data were unavailable for 2 patients. Overall, excluding the 2 patients who died and the 2 we have no TPN data on, of 23 patients, 21 (91%) are now off TPN.
Our series shows improved results not only with survival but also in the number of patients that are off TPN. Multidisciplinary approach consisting of both medical and surgical expertise is necessary in the management of these patients. The authors advocate centralisation of short gut services to experienced centers with multidisciplinary expertise.
短肠综合征对儿科团队构成了巨大挑战。全胃肠外营养（TPN）管理和肠重建手术的一些创新技术改善了这些儿童的预后。作者介绍了他们作为一个专科单位在过去十年中使用改进的技术和多学科方法来管理这种疾病的经验。
确定了 2000 年至 2009 年间出现短肠综合征的所有儿童。记录诊断、残留肠长度、确定性手术时的年龄、肠预延长长度、肠后延长长度、TPN 状态和存活率。计算中位数。
共确定了 27 名儿童（男 14 例，女 13 例）。总存活率为 92%。有 2 名儿童死亡。19 名儿童需要肠延长，8 名儿童根据我们的方案进行简单肠重建。确定性手术的总中位年龄为 12 个月。这些患者的总残留肠长度中位数为 35.5cm，而接受肠延长的患者的残留肠长度中位数为 25cm。肠延长后，肠道长度中位数为 90cm。2 名患者的 TPN 数据不可用。总体而言，在排除了 2 名死亡的患者和 2 名我们没有 TPN 数据的患者后，23 名患者中，有 21 名（91%）现在已停止 TPN。
我们的系列结果不仅显示存活率提高，而且显示停止 TPN 的患者数量增加。这些患者的管理需要由医疗和外科专业知识组成的多学科方法。作者主张将短肠服务集中到具有多学科专业知识的经验丰富的中心。
