Artificial Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy.
Hepatology Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy.
Nutrients. 2020 Jul 18;12(7):2136. doi: 10.3390/nu12072136.
Pediatric Short Bowel Syndrome (SBS) can require prolonged parenteral nutrition (PN). Over the years, SBS management has been implemented by autologous gastrointestinal reconstructive surgery (AGIR). The primary objective of the present review was to assess the effect of AGIR on weaning off PN. We also evaluated how AGIR impacts survival, the need for transplantation (Tx) and the development of liver disease (LD). We conducted a systematic literature search to identify studies published from January 1999 to the present and 947 patients were identified. PN alone was weakly associated with higher probability of weaning from PN (OR = 1.1, = 0.03) and of surviving (OR = 1.05, = 0.01). Adjusting for age, the probability of weaning off PN but of not surviving remained significantly associated with PN alone (OR = 1.08, = 0.03). Finally, adjusting for age and primary diagnosis (gastroschisis), any association was lost. The prevalence of TX and LD did not differ by groups. In conclusion, in view of the low benefit in terms of intestinal adaptation and of the not negligible rate of complications (20%), a careful selection of candidates for AGIR should be required. Bowel dilation associated with failure of advancing EN and poor growth, should be criteria to refer for AGIR.
儿科短肠综合征（SBS）可能需要长期肠外营养（PN）。多年来，SBS 的治疗一直采用自体胃肠道重建手术（AGIR）。本综述的主要目的是评估 AGIR 对停止 PN 的影响。我们还评估了 AGIR 如何影响存活率、移植（Tx）的需求和肝病（LD）的发展。我们进行了系统的文献检索，以确定自 1999 年 1 月至今发表的研究，共确定了 947 名患者。单独使用 PN 与更高的 PN 脱机可能性（OR = 1.1， = 0.03）和存活率（OR = 1.05， = 0.01）相关较弱。调整年龄后，PN 单独与脱机可能性但存活率的关联仍然显著（OR = 1.08， = 0.03）。最后，调整年龄和主要诊断（先天性腹裂）后，任何关联均消失。Tx 和 LD 的患病率在各组之间无差异。总之，鉴于在肠道适应方面的益处较低，且并发症发生率较高（20%），应慎重选择 AGIR 的候选者。肠扩张伴肠内营养推进失败和生长不良应作为转至 AGIR 的标准。
