*Pediatric Liver and Gut Research Group, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland †Section of Pediatric Surgery, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland ‡HUS Medical Imaging Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland §Section of Pediatric Gastroenterology, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Ann Surg. 2017 Aug;266(2):369-375. doi: 10.1097/SLA.0000000000001893.
To analyze risk factors and prognostic significance of small bowel (SB) dilatation in children with short bowel syndrome (SBS).
In SBS, the remaining SB may dilate as part of intestinal adaptation. The impact of dilatation on parenteral nutrition (PN) dependence and survival has not been studied systematically.
SB diameter of SBS children (n = 61) was measured in contrast SB series (n = 169, median age 0.94, range 0.32-2.7 years) during 2002 to 2015, and expressed as millimeters (SB width) and as ratio to L5 vertebra height (SB diameter ratio). Linear regression was used to examine risk factors for dilatation. PN weaning and survival were analyzed with Cox proportional hazards regression.
Maximal SB diameter ratio during follow-up was predicted by PN dependence and SB atresia, while maximal absolute SB width by birth weight, age, PN duration, and remaining bowel length. Weaning off PN was 14-fold more likely in patients with maximal SB diameter ratio <2.00 compared with >3.00 (P = 0.005), and 5.4-fold more likely when maximal SB width was <20 mm compared with >30 mm (P = 0.023). After adjustment for age, remaining SB length, and the presence of ileocecal valve, both estimates of maximal SB dilatation remained significant independent predictors for weaning off PN. When all measurements were included, the cumulative survival was worse if SB diameter ratio exceeded 2.00 (P = 0.002-0.042).
SB dilatation predicts prolonged PN duration and decreased survival in SBS children. Measurement of maximal SB diameter standardized to L5 vertebra height may be a valuable objective tool for patient follow-up and assessment of prognosis.
分析小儿短肠综合征（SBS）患者小肠（SB）扩张的危险因素和预后意义。
在 SBS 中，剩余的 SB 可能会扩张，这是肠道适应的一部分。SB 扩张对肠外营养（PN）依赖和生存的影响尚未得到系统研究。
在 2002 年至 2015 年期间，对 61 名 SBS 儿童的 SB 直径进行对比 SB 系列测量（n = 169，中位年龄 0.94 岁，范围 0.32-2.7 岁），并用毫米（SB 宽度）和 L5 椎骨高度（SB 直径比）表示。线性回归用于检查扩张的危险因素。用 Cox 比例风险回归分析 PN 断奶和生存情况。
随访期间最大 SB 直径比由 PN 依赖和 SB 闭锁预测，而最大绝对 SB 宽度由出生体重、年龄、PN 持续时间和剩余肠长度预测。与最大 SB 直径比>3.00 相比，最大 SB 直径比<2.00 的患者 PN 断奶的可能性高 14 倍（P = 0.005），与最大 SB 宽度>30mm 相比，最大 SB 宽度<20mm 的患者 PN 断奶的可能性高 5.4 倍（P = 0.023）。在校正年龄、剩余 SB 长度和回盲瓣存在后，最大 SB 扩张的这两个估计值仍然是 PN 断奶的独立预测因素。当所有测量值都包括在内时，如果 SB 直径比超过 2.00，则累积生存率更差（P = 0.002-0.042）。
SB 扩张预测 SBS 儿童 PN 持续时间延长和生存率降低。最大 SB 直径标准化至 L5 椎骨高度的测量可能是患者随访和预后评估的一种有价值的客观工具。
