Kaufman S S, Loseke C A, Lupo J V, Young R J, Murray N D, Pinch L W, Vanderhoof J A
Joint Section of Pediatric Gastroenterology, Creighton University, Omaha, Nebraska 68114, USA.
J Pediatr. 1997 Sep;131(3):356-61. doi: 10.1016/s0022-3476(97)80058-3.
Massive intestinal resection results in short bowel syndrome and necessitates prolonged parenteral feeding. The purpose of this work was to assess the impact of late complications of short bowel syndrome, including intestinal bacterial overgrowth and enterocolitis, on the duration of parenteral nutrition (PN) in comparison with factors evident in the neonatal period.
Retrospective chart review.
Of 49 children, 42 were weaned from parenteral nutrition after a treatment course of 17 +/- 14 months. In these 42, postresection small intestinal length equaled 81 +/- 65 cm; 45% had an ileocecal valve. Small intestinal length in the seven children who were PN dependent was 31 +/- 30 cm (p < 0.05); none had an ileocecal valve (p < 0.05). Bacterial overgrowth occurred in all seven PN-dependent children and in 23 of 42 children eventually weaned from PN (p < 0.05). When bacterial overgrowth was identified before weaning (n = 12), the duration pf PN was 28 +/- 17 months, but when bacterial overgrowth was first identified only after weaning (n = 11), the duration of PN was 16 +/- 13 months (p < 0.05). Small intestinal inflammation correlated with bacterial overgrowth (r = 0.69). Those children with severe enteritis identified before weaning remained on the PN regimen for 36 +/- 15 months, in comparison with 21 +/- 14 months in those with mild enteritis and 13 +/- 11 months in those without inflammation (p < 0.02).
Although the length of small intestine remaining after resection is the best immediate predictor of final success in terminating PN in children with short bowel syndrome, PN is prolonged by bacterial overgrowth and associated enteritis in those who will ultimately be weaned.
大规模肠道切除会导致短肠综合征，并需要长期肠外营养支持。本研究旨在评估短肠综合征的晚期并发症，包括肠道细菌过度生长和小肠结肠炎，与新生儿期明显的因素相比，对肠外营养（PN）持续时间的影响。
回顾性病历审查。
49名儿童中，42名在17±14个月的治疗过程后停止了肠外营养。在这42名儿童中，切除术后小肠长度为81±65cm；45%的儿童有回盲瓣。7名依赖PN的儿童小肠长度为31±30cm（p<0.05）；均无回盲瓣（p<0.05）。所有7名依赖PN的儿童以及42名最终停止PN的儿童中有23名发生了细菌过度生长（p<0.05）。在停止PN前发现细菌过度生长的患儿（n = 12），PN持续时间为28±17个月，而仅在停止PN后首次发现细菌过度生长的患儿（n = 11），PN持续时间为16±13个月（p<0.05）。小肠炎症与细菌过度生长相关（r = 0.69）。在停止PN前被诊断为重症肠炎的患儿，PN治疗持续36±15个月，而轻度肠炎患儿为21±14个月，无炎症患儿为13±11个月（p<0.02）。
虽然切除术后剩余小肠的长度是短肠综合征患儿最终成功停止PN的最佳直接预测指标，但细菌过度生长和相关肠炎会延长最终能够停止PN的患儿的PN持续时间。
