Harju E J, Pessi T T
Int Surg. 1987 Jan-Mar;72(1):25-9.
A report is presented on patients (no. = 43. 64 +/- 9 years, 30 men and 13 women) subjected to a massive small bowel resection (69 +/- 25 cm intestine left). The most usual indication was thromboembolism of the arteria mesenterica superioris, but there were also patients who had had intestinal by-pass, occlusion, trauma, tumor and invagination. The preoperative diagnosis was based on peritonitis, increasing abdominal symptoms, paralytic ileus, shock and fever. Fluid and electrolyte treatment, postoperative intensive care, intestinal decompression, parenteral nutrition and antibiotics were also employed. Postoperatively there was a significant decrease in serum protein (SP) (63 +/- 11 vs. 43 +/- 9 g/l) and blood hemoglobin (150 +/- 10 vs. 106 +/- 8 g/l) concentrations (Hb) and hematocrit (CHCT) (0.44 +/- 0.11 vs. 0.31 +/- 0.10). Also the number of patients with subnormal SP and Hb increased from five to nineteen and from fourteen to thirty-two, respectively. The operative mortality (within 30 days) was 60 percent (26/43). Those who survived were younger (59 +/- 8 vs. 67 +/- 9 years) and had higher SP (87 +/- 12 vs. 47 +/- 11 g/l), blood leukocyte count (22 +/- 6 vs. 14 +/- 5 X 10(9] and lower peroperative blood loss (291 +/- 43 vs. 448 +/- 67) than those who died. During the one to 14 year follow-up time nine (21% of all patients and 59% of those who were discharged) were still alive. Thus the patients subjected to a massive small bowel resection are old, have atherosclerotic cardiovascular diseases and preoperatively have peritonitis or severe abdominal complaints and an impaired nutritional state and fluid balance.
报告呈现了接受大量小肠切除术（剩余小肠69±25厘米）的患者情况（共43例，年龄64±9岁，男性30例，女性13例）。最常见的指征是肠系膜上动脉血栓栓塞，但也有患者曾接受肠道旁路手术、肠梗阻、创伤、肿瘤和肠套叠手术。术前诊断基于腹膜炎、腹部症状加重、麻痹性肠梗阻、休克和发热。还采用了液体和电解质治疗、术后重症监护、肠道减压、肠外营养和抗生素治疗。术后血清蛋白（SP）浓度（63±11 vs. 43±9 g/L）、血红蛋白（Hb）（150±10 vs. 106±8 g/L）和血细胞比容（CHCT）（0.44±0.11 vs. 0.31±0.10）显著下降。SP和Hb低于正常水平的患者数量也分别从5例增加到19例和从14例增加到32例。手术死亡率（30天内）为60%（26/43）。存活者比死亡者更年轻（59±8 vs. 67±9岁），SP更高（87±12 vs. 47±11 g/L），血白细胞计数更高（22±6 vs. 14±5×10⁹），术中失血量更低（291±43 vs. 448±67）。在1至14年的随访期内，9例（占所有患者的21%，出院患者的59%）仍存活。因此，接受大量小肠切除术的患者年龄较大，患有动脉粥样硬化性心血管疾病，术前患有腹膜炎或严重腹部不适，营养状况和液体平衡受损。
