Kaji Tatsuru, Nakame Kazuhiko, Machigashira Seiro, Kawano Takafumi, Masuya Ryuta, Yamada Waka, Yamada Koji, Onishi Shun, Moriguchi Tomoe, Sugita Koshiro, Mukai Motoi, Ieiri Satoshi
Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
Surg Today. 2017 Nov;47(11):1391-1396. doi: 10.1007/s00595-017-1534-6. Epub 2017 Apr 22.
Short-bowel syndrome (SBS) is associated with high morbidity and mortality. We conducted this study to establish the predictors of survival and weaning off parenteral nutrition (PN).
We reviewed the medical records of 16 SBS infants treated at our institution within a 30-year period. SBS was defined as a residual small-bowel length (RSBL) of <75 cm. Loss of the ileocecal valve (ICV), cholestasis (D-Bil >2.0 mg/dl), enterostomy, and RSBL were all evaluated. Kaplan-Meier analysis was used to analyze the predictors.
The mean RSBL was 34.9 ± 22.9 cm. Six patients died (37.5%) and nine patients were weaned off PN (56.3%). Significant differences were observed in cholestasis (p < 0.03), enterostomy (p < 0.01), an absolute RSBL of <30 cm (p < 0.04), and a percentage of expected RSBL of <10% (p < 0.04) as survival predictors. Significant differences were also observed for cholestasis (p < 0.01), loss of the ICV (p < 0.04), an absolute RSBL of <20 cm (p < 0.01), and a percentage of expected RSBL of <10% (p < 0.03) as predictors of weaning off PN.
These predictors may help us select the optimal treatments for pediatric patients with SBS.
短肠综合征（SBS）与高发病率和死亡率相关。我们开展本研究以确定生存及停用肠外营养（PN）的预测因素。
我们回顾了30年间在我院接受治疗的16例SBS婴儿的病历。SBS定义为残余小肠长度（RSBL）<75 cm。对回盲瓣（ICV）缺失、胆汁淤积（直接胆红素>2.0 mg/dl）、肠造口术和RSBL均进行了评估。采用Kaplan-Meier分析来分析预测因素。
平均RSBL为34.9±22.9 cm。6例患者死亡（37.5%），9例患者停用PN（56.3%）。在胆汁淤积（p<0.03）、肠造口术（p<0.01）、绝对RSBL<30 cm（p<0.04）以及预期RSBL百分比<10%（p<0.04）方面，作为生存预测因素存在显著差异。在胆汁淤积（p<0.01）、ICV缺失（p<0.04）、绝对RSBL<20 cm（p<0.01）以及预期RSBL百分比<10%（p<0.03）方面，作为停用PN的预测因素也存在显著差异。
这些预测因素可能有助于我们为患有SBS的儿科患者选择最佳治疗方法。
