Transplant Center, Cleveland Clinic, Cleveland, Ohio, USA.
Curr Opin Organ Transplant. 2023 Jun 1;28(3):228-236. doi: 10.1097/MOT.0000000000001070. Epub 2023 Apr 4.
With the inherent therapeutic limitations of gut transplantation, the concept of surgical gut rehabilitation was introduced to restore nutritional autonomy in pediatric patients. With favorable outcomes in these young patients, there has been increasing interest in the applicability of gut rehabilitative surgery to a growing population of adults with gut failure due to various etiologies. We aim to review the current status of surgical gut rehabilitation for adult gut failure patients in the era of multidisciplinary gut rehabilitation and transplantation.
Indications for surgical gut rehabilitation have been gradually expanding, with gut failure after bariatric surgery recently added. Serial transverse enteroplasty (STEP) has been used with favorable outcomes in adult patients, including those with intrinsic intestinal disease. Autologous gut reconstruction (AGR) is the most frequently used surgical rehabilitative method; its outcome is further improved with conjunctive use of bowel lengthening and enterocyte growth factor as a part of comprehensive gut rehabilitation.
Accumulated experiences have validated the efficacy of gut rehabilitation for survival, nutritional autonomy, and quality of life in adults with gut failure of various etiology. Further progress is expected with growing experience around the world.
由于肠移植存在固有的治疗局限性，因此引入了外科肠道康复的概念，以恢复儿科患者的营养自主性。由于这些年轻患者的结果良好，因此越来越多的人对肠道康复手术在由于各种病因导致肠道衰竭的成年人群中的适用性感兴趣。我们旨在回顾在多学科肠道康复和移植时代，外科肠道康复治疗成人肠道衰竭患者的现状。
外科肠道康复的适应证逐渐扩大，最近又增加了减肥手术后的肠道衰竭。连续横结肠切开术（STEP）已在成年患者中取得良好效果，包括患有内在肠道疾病的患者。自体肠重建（AGR）是最常用的外科康复方法；将肠延长和肠细胞生长因子联合使用作为综合肠道康复的一部分，可进一步改善其结果。
积累的经验验证了肠道康复对各种病因导致的肠道衰竭的成年患者的生存、营养自主性和生活质量的疗效。随着全球经验的不断增加，预计会取得进一步进展。
