Bianchi A
Neonatal Surgical Unit, St Mary's Hospital, Manchester, England.
J R Soc Med. 1997 Aug;90(8):429-32. doi: 10.1177/014107689709000804.
Longitudinal intestinal lengthening and tailoring (LILT) is increasingly favoured as a treatment for short-bowel syndrome. In a personal series, 20 children underwent LILT between 1962 and 1997. There was negligible morbidity (hemiloop anastomotic stenosis in 2) and no operative mortality. At a mean follow-up of 6.4 years overall survival was 45%, and certain features were clearly related to outcome. Survivors had > 40 cm of residual small bowel (commonly jejunum) and had little hepatic dysfunction despite parenteral nutrition of similar time and nature as non-survivors. Children who did not survive had < 40 cm of residual small bowel and developed early lethal hepatic dysfunction of unclear aetiology. Outcome did not seem to be influenced by the presence of the ileocaecal valve or the length of residual colon. Children born with short-bowel should be offered LILT at an early stage when still in good physical condition, so as to avoid liver-damaging intraluminal stasis and bacterial translocation and to enhance intestinal adaptation and hepatoprotective factors.
纵向肠道延长与裁剪术（LILT）越来越多地被用作短肠综合征的一种治疗方法。在一项个人病例系列研究中，1962年至1997年间有20名儿童接受了LILT手术。并发症发生率极低（2例出现半肠吻合口狭窄），且无手术死亡病例。平均随访6.4年，总体生存率为45%，某些特征与预后明显相关。存活者残余小肠（通常为空肠）长度>40 cm，尽管与非存活者接受的肠外营养在时间和性质上相似，但肝功能损害较小。未存活的儿童残余小肠长度<40 cm，并出现病因不明的早期致命性肝功能障碍。回盲瓣的存在或残余结肠的长度似乎并未影响预后。患有短肠的儿童应在身体状况尚好的早期阶段接受LILT手术，以避免损害肝脏的肠腔内淤滞和细菌易位，并增强肠道适应性和肝脏保护因子。
