Velazco Cristine S, Fullerton Brenna S, Brazzo Joseph A, Hong Charles R, Jaksic Tom, Barnewolt Carol E
Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA; Department of Surgery Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Department of Surgery Boston Children's Hospital, Boston, MA.
J Pediatr Surg. 2017 Dec;52(12):1921-1924. doi: 10.1016/j.jpedsurg.2017.08.055. Epub 2017 Sep 5.
Small bowel length is the most reliable predictor of enteral independence in pediatric short bowel syndrome. Retrospectively measured bowel lengths on upper GI with small bowel follow-through (UGI/SBFT) were compared to operative measurements.
A pediatric radiologist and surgical trainees blinded to operative measurements retrospectively analyzed UGI/SBFT studies using the digital radiography curved measurement tool. Children with SBS and severe intestinal failure (parenteral nutrition >90days) at a multidisciplinary intestinal failure program 2002-2015 were included. Data were expressed as median (Q1, Q3).
Thirty-six children aged 0.8 (0.4, 3.7) years were analyzed. Fifty-six percent had intestinal malrotation, and 58% had prior serial transverse enteroplasty. Studies were conducted within 10 (7, 20) days of surgery. Intraoperative bowel length was 90cm (45, 142), while UGI/SBFT measurement by radiologist was 45cm (28, 63), with a mean difference of 47cm (SD 58cm, p<0.001) and a mean percent error of 50%. Radiographic assessment underestimated intestinal length in 83% of patients.
Bowel length measured retrospectively from upper GI with small bowel follow-through studies usually underestimated intraoperative bowel length. The limits of agreement were too wide for this technique to be clinically useful. Operative measurement remains necessary to assess intestinal length and rehabilitation potential.
Study of Diagnostic Test.
Level III.
小肠长度是小儿短肠综合征肠内营养独立最可靠的预测指标。将上消化道造影小肠造影（UGI/SBFT）回顾性测量的肠长度与手术测量值进行比较。
一名儿科放射科医生和外科实习生在不知道手术测量值的情况下，使用数字放射摄影曲线测量工具对UGI/SBFT研究进行回顾性分析。纳入2002年至2015年在多学科肠衰竭项目中患有短肠综合征和严重肠衰竭（肠外营养>90天）的儿童。数据以中位数（Q1，Q3）表示。
分析了36名年龄为0.8（0.4，3.7）岁的儿童。56%的儿童有肠旋转不良，58%的儿童曾接受过系列横向肠成形术。研究在手术后10（7，20）天内进行。术中肠长度为90cm（45，142），而放射科医生通过UGI/SBFT测量的长度为45cm（28，63），平均差异为47cm（标准差58cm，p<0.001），平均百分比误差为50%。83%的患者放射学评估低估了肠长度。
通过上消化道造影小肠造影研究回顾性测量的肠长度通常低估术中肠长度。该技术的一致性界限过宽，在临床上无实用价值。评估肠长度和康复潜力仍需进行手术测量。
诊断试验研究。
三级。
