Lennard-Jones J E
St Mark's Hospital, London, UK.
Aliment Pharmacol Ther. 1994 Dec;8(6):563-77. doi: 10.1111/j.1365-2036.1994.tb00332.x.
A shortened small intestine may end at a stoma or be anastomosed to the colon. Patients with a jejunostomy, but not those with a colon, lose large amounts of sodium. The intake and absorption of sodium can be increased by sipping a sodium-glucose solution; stomal loss can be reduced by restricting water or low-sodium drinks. If a stoma is situated less than 100 cm along the jejunum, a constant negative sodium balance may necessitate parenteral saline supplements. Gastric anti-secretory drugs or a somatostatin analogue reduce jejunostomy losses in such patients but do not restore a positive sodium balance. Loperamide or codeine phosphate benefit some patients. Magnesium deficiency can usually be corrected by oral magnesium oxide supplements. An elemental or hydrolysed diet is not beneficial. Patients with a jejunostomy can maintain a normal diet without fat reduction. When the colon is present, unabsorbed carbohydrate is fermented to absorbable short chain fatty acids. Unabsorbed long chain fatty acids and bile salts cause watery diarrhoea and increased colonic oxalate absorption with hyperoxaluria. Such patients benefit from a high carbohydrate, low-fat and low-oxalate diet. Parenteral nutrition is needed only by the few patients unable to maintain health or avoid socially disabling diarrhoea despite these measures.
缩短的小肠可能在造口处终止，或与结肠吻合。空肠造口的患者会大量丢失钠，但结肠造口的患者不会。通过小口饮用钠-葡萄糖溶液可增加钠的摄入和吸收；通过限制饮水或饮用低钠饮料可减少造口处的钠丢失。如果造口位于空肠距起始部不到100 cm处，持续的负钠平衡可能需要胃肠外补充生理盐水。胃分泌抑制药物或生长抑素类似物可减少此类患者的空肠造口钠丢失，但不能恢复正钠平衡。洛哌丁胺或磷酸可待因对一些患者有益。镁缺乏通常可通过口服氧化镁补充剂来纠正。要素饮食或水解饮食并无益处。空肠造口的患者可维持正常饮食，无需减少脂肪摄入。当结肠存在时，未吸收的碳水化合物会发酵成可吸收的短链脂肪酸。未吸收的长链脂肪酸和胆盐会导致水样腹泻，并增加结肠草酸盐的吸收，从而导致高草酸尿症。此类患者受益于高碳水化合物、低脂肪和低草酸盐饮食。只有少数患者尽管采取了这些措施仍无法维持健康或避免出现导致社交障碍的腹泻，才需要胃肠外营养。
