Thompson J S
J Surg Res. 1985 Jul;39(1):81-91. doi: 10.1016/0022-4804(85)90165-9.
The introduction of total parenteral nutrition has resulted in more patients surviving massive intestinal resection. Long-term parenteral nutrition is expensive, has potential complications, and causes inconvenience for the patient. Therefore, interest persists in surgical therapy for the short bowel syndrome. The goals of surgical therapy in the short bowel syndrome are to slow intestinal transit, increase the area of absorption, and reduce gastric hyperacidity. Patients with sufficient absorptive area, but rapid intestinal transit, benefit from antiperistaltic segments or colon interposition. Intestinal valves yield inconsistent results. Recirculating loops are associated with prohibitive morbidity and mortality. Experience with intestinal pacing is limited. Patients with dilated bowel segments may benefit from intestinal tapering or lengthening. Growing neomucosa holds promise but has not been evaluated clinically. Recent improvement in the results of intestinal transplantation in animals may warrant clinical trials. The efficacy of H2 receptor antagonists makes procedures for reducing gastric hyperacidity less necessary. None of the operations to treat the short bowel syndrome are sufficiently safe and effective to recommend their routine use. Operations should be performed only on selected patients to achieve specific goals. Although investigation continues, our emphasis should continue to be conservation of as much of the intestine as possible when massive resection is necessary.
全胃肠外营养的引入使得更多接受大规模肠道切除的患者得以存活。长期胃肠外营养费用高昂，存在潜在并发症，且给患者带来不便。因此，对于短肠综合征的外科治疗仍备受关注。短肠综合征外科治疗的目标是减缓肠道蠕动、增加吸收面积并降低胃酸过多。吸收面积足够但肠道蠕动过快的患者可从抗蠕动段或结肠插入术中获益。肠瓣膜的效果并不一致。再循环肠袢与过高的发病率和死亡率相关。肠道起搏的经验有限。肠段扩张的患者可能从肠道缩窄或延长术中获益。新黏膜生长前景良好，但尚未进行临床评估。动物肠道移植结果的近期改善可能值得进行临床试验。H2受体拮抗剂的疗效使得减少胃酸过多的手术必要性降低。治疗短肠综合征的手术均不够安全有效，不足以推荐常规使用。手术仅应在选定患者身上进行以实现特定目标。尽管研究仍在继续，但当必须进行大规模切除时，我们仍应继续强调尽可能保留更多的肠道。
