减重手术后肠衰竭：单中心肠康复和移植治疗和结局。
Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center.
机构信息
The Dumont UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California; Hepato-Pancreato-Biliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Nakhon Pathom, Thailand.
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California.
出版信息
Surg Obes Relat Dis. 2019 Jan;15(1):98-108. doi: 10.1016/j.soard.2018.10.014. Epub 2018 Nov 28.
BACKGROUND
Though intestinal failure (IF) after bariatric surgery (BS) is uncommon, its prevalence is increasing. However, data on the outcomes for these patients are limited.
OBJECTIVES
To analyze the outcomes of treatment for patients with IF after BS.
SETTING
University hospital.
METHODS
A single-center analysis (1991-2016) of outcomes according to treatment arms established by a multidisciplinary team.
RESULTS
Twenty-five IF patients were identified (median age 45 yr). BS was 92% Roux-en-Y gastric bypass. The major cause of IF was volvulus/internal hernia (72%). Median time from BS to IF was 48 months. Treatment arms were intestinal rehabilitation (IR, n = 15), transplantation (TXP, n = 5), and parenteral nutrition (PN, n = 5). For IR, median bowel length was 60 cm. Forty-six percent ultimately discontinued PN. Twenty-seven percent were partially weaned PN and 27% failed IR. Common surgical rehabilitation was Roux-en-Y gastric bypass reversal and restoration of gastrointestinal continuity. The 5-year overall survival was 74%. For TXP, 7 patients were listed for TXP (5 initially and 2 after failed IR). Three underwent TXP, 2 isolated intestine and 1 isolated liver. Three were delisted (1 improvement and 2 death). For PN, 6 patients required long-term PN (5 initially and 1 after failed IR). Four patients are alive currently.
CONCLUSIONS
IF after BS is an increasing problem facing IR centers. Internal hernia is the major cause. Surgical IR is the first-line therapy and affords the best outcome. TXP is reserved for rescuing patients who failed IR or develop PN complications. Long-term PN is suitable for patients in whom IR or TXP is impractical.
背景
尽管减重手术后发生肠衰竭（IF）并不常见，但它的发病率正在上升。然而，关于这些患者治疗结果的数据有限。
目的
分析减重手术后 IF 患者的治疗结果。
设置
大学医院。
方法
对多学科团队制定的治疗分组进行回顾性分析（1991-2016 年）。
结果
共确定了 25 例 IF 患者（中位年龄 45 岁）。BS 为 92%的 Roux-en-Y 胃旁路术。IF 的主要病因是扭转/内疝（72%）。BS 到 IF 的中位时间为 48 个月。治疗分组为肠康复（IR，n=15）、移植（TXP，n=5）和肠外营养（PN，n=5）。IR 组的中位肠段长度为 60cm。46%的患者最终停止了 PN。27%的患者部分减少了 PN，27%的患者 IR 失败。常见的手术康复方式为 Roux-en-Y 胃旁路术逆转和胃肠道连续性恢复。5 年总生存率为 74%。对于 TXP，有 7 例患者被列入 TXP 名单（最初有 5 例，IR 失败后有 2 例）。3 例接受了 TXP，2 例单纯肠移植，1 例单纯肝移植。3 例患者被取消资格（1 例病情改善，2 例死亡）。对于 PN，6 例患者需要长期 PN（最初有 5 例，IR 失败后有 1 例）。目前有 4 例患者存活。
结论
BS 后 IF 是 IR 中心面临的一个日益严重的问题。内疝是主要病因。手术 IR 是一线治疗方法，效果最佳。TXP 是为那些 IR 或 PN 并发症失败的患者保留的。长期 PN 适用于不适合 IR 或 TXP 的患者。
Zotero 插件