Intestinal Rehabilitation Team, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.
Intestinal Rehabilitation Team, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea.
Asian J Surg. 2021 Mar;44(3):549-552. doi: 10.1016/j.asjsur.2020.11.010. Epub 2020 Nov 28.
Type II (acute) intestinal failure (IF) is usually caused by complications of abdominal surgery resulting in enteric fistulas or proximal stomas and requires parenteral nutrition (PN) for several months. This study aimed to evaluate clinical management and outcome of type II IF patients in a single center.
Medical records of patients referred to the Intestinal Rehabilitation Team (IRT) at Samsung Medical Center (Seoul, Korea) were retrospectively analyzed.
From 2014 to 2019, 34 patients with IF were referred. 28 patients were type II IF and were included in the analysis. There were 17 males and 11 females. Mean age of patients was 56.7 years. Pathophysiology of IF were high-output stoma in 16 cases, extensive bowel resection (with bowel in continuity) in 7 cases, and enterocutaneous fistula in 5 cases. The catastrophic events necessitating abdominal surgery in the patients were adhesive ileus in 9 cases, superior mesenteric artery thrombosis in 8 cases, internal herniation of bowel in 5 cases, traumatic bowel injury in 3 cases, and ischemic enteritis in 3 cases. Following medical and surgical rehabilitation, 10 patients (35.7%) were weaned off PN and overall mortality was 28.5%. Deaths were related to progression of underlying malignancies in 4 cases, liver failure in 3 cases, and sepsis in 1 case. Thirteen patients underwent surgery to restore bowel continuity. Six postoperative complications occurred in 4 patients (30.7%) and there were no postoperative mortalities.
Standardized care including restorative surgery resulted in successful outcomes in type II IF patients in this cohort.
II 型（急性）肠衰竭（IF）通常由腹部手术并发症引起，导致肠瘘或近端造口，并需要数月的肠外营养（PN）。本研究旨在评估单中心 II 型 IF 患者的临床管理和结局。
回顾性分析了 2014 年至 2019 年期间转诊至三星医疗中心（韩国首尔）肠道康复治疗组（IRT）的患者的病历。
共有 34 例 IF 患者转诊，其中 28 例为 II 型 IF，纳入分析。患者中男性 17 例，女性 11 例。患者的平均年龄为 56.7 岁。IF 的发病机制包括 16 例高输出造口、7 例广泛肠切除术（连续性肠段）和 5 例肠外瘘。需要腹部手术的灾难性事件包括粘连性肠梗阻 9 例、肠系膜上动脉血栓形成 8 例、肠内疝 5 例、创伤性肠损伤 3 例和缺血性肠炎 3 例。在接受医疗和手术康复治疗后，10 例（35.7%）患者成功脱离 PN，总体死亡率为 28.5%。死亡与 4 例基础恶性肿瘤进展、3 例肝功能衰竭和 1 例脓毒症有关。13 例患者接受了恢复肠道连续性的手术。4 例患者（30.7%）发生 6 例术后并发症，无术后死亡。
在本队列中，包括修复手术在内的标准化治疗使 II 型 IF 患者取得了良好的结局。
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