Department of Pediatric Surgery, Assistance Publique des Hôpitaux de Marseille, Hôpital Timone Enfants, Marseille, France.
Department of Pediatric Surgery, Hospiltal Infantil La Paz, Madrid, Spain.
Eur J Pediatr Surg. 2021 Feb;31(1):8-13. doi: 10.1055/s-0040-1721040. Epub 2020 Nov 16.
The aim of this study was to assess the management of short-bowel syndrome (SBS) at the time of primary surgery, and the strategies used to facilitate enteral autonomy depending on the institutional expertise.
An online questionnaire was sent in 2019 to members of The European Pediatric Surgeons' Association.
Among the 65 responding members (26 countries, 85% from university hospitals), 57% manage less than three new patients with SBS per year (group A), and 43% at least three patients (group B). The cut-off of three patients treated yearly used in our study was defined after statistical analysis of different cut-offs. A multidisciplinary intestinal rehabilitation program is significantly more frequent in group B than in group A (85 and 53%, respectively; = 0.009). Considering the primary surgical management of multiple intestinal atresia and congenital ultra-short bowel with jejunal atresia, primary surgical strategies to optimize bowel length are more often used in group B than group A ( = 0.09 and = 0.04, respectively). A minimum of one intestinal lengthening procedure every 2 to 3 years is significantly more frequent in group B than group A (95 and 45%, respectively; = 0.0013). Among the strategies used to promote intestinal adaptation, group B (35%) uses significantly more often glucagon-like peptide 2 analogs than group A (10%) ( = 0.02).
Based on our survey, a minimum number of SBS patients treated yearly is required to manage this challenging disease according to up-to-date medical and surgical strategies. However, whatever their level of expertise is in managing SBS, most of pediatric surgeons are involved in the primary surgery. Medical education programs about SBS should be more largely available to pediatric surgeons.
本研究旨在评估初次手术时短肠综合征（SBS）的治疗方法，并根据机构专业知识评估促进肠内自主的策略。
2019 年，我们向欧洲小儿外科学会成员发送了一份在线问卷。
在 65 名回复的成员（来自 26 个国家，85%来自大学医院）中，57%的人每年管理的 SBS 新患者少于 3 例（A 组），43%的人管理至少 3 例（B 组）。我们研究中使用的每年治疗 3 例患者的截止值是在对不同截止值进行统计分析后确定的。与 A 组相比，B 组更常采用多学科肠道康复计划（85%和 53%， = 0.009）。考虑到多发性肠闭锁和先天性超短肠伴空肠闭锁的初次手术治疗，B 组比 A 组更常采用优化肠长度的初次手术策略（ = 0.09 和 = 0.04）。B 组比 A 组更常每 2-3 年进行一次肠延长手术（95%和 45%， = 0.0013）。在促进肠道适应的策略中，B 组（35%）比 A 组（10%）更常使用胰高血糖素样肽 2 类似物（ = 0.02）。
根据我们的调查，每年需要治疗一定数量的 SBS 患者，才能根据最新的医学和外科策略来治疗这种具有挑战性的疾病。然而，无论他们管理 SBS 的专业水平如何，大多数小儿外科医生都参与初次手术。应该向小儿外科医生提供更多关于 SBS 的医学教育课程。
