Wilmore D W, Lacey J M, Soultanakis R P, Bosch R L, Byrne T A
Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Ann Surg. 1997 Sep;226(3):288-92; discussion 292-3. doi: 10.1097/00000658-199709000-00008.
The authors determined those factors that predict a successful outcome in patients who receive pharmacologic agents to promote bowel absorption after massive intestinal resection.
Patients with the short bowel syndrome are maintained on long-term total parenteral nutrition (TPN) or more frequently considered for intestinal transplantation as part of their treatment program. The authors have administered a combination of trophic agents and a specialized diet to further enhance intestinal compensation and optimize nutrient absorption in patients with intestinal failure.
Forty-five TPN-dependent adults with a jejunal-ileal remnant < or = 50 cm and a portion of colon in continuity were treated with growth hormone, glutamine, and a modified diet for 4 weeks and observed for an average of 1.8 years.
The average age of the patients was 43 years, the average jejunal-ileal length was 23 cm, and the average length of time the patient received TPN was 4.3 years. After 4 weeks of therapy, 26 (58%) were free of TPN support. Predictors of a favorable response included greater bowel length, lower body weight, and greater bowel length-body weight ratio. At follow-up, the percentage of patients who were not receiving TPN had fallen to 40%.
Approximately half of a group of patients, thought to have absorptive surface area inadequate to be independent of TPN support, can maintain themselves on enteral feedings after this intestinal rehabilitation program. Because of the risk, costs, and alterations in lifestyle associated with long-term TPN or intestinal transplantation or both, it seems prudent to consider a program of bowel rehabilitation with an individual patient before embarking on another therapeutic plan.
作者确定了那些能预测接受促进肠道吸收的药物治疗的患者获得成功治疗结果的因素，这些患者均接受了大量肠道切除手术。
短肠综合征患者需长期接受全胃肠外营养（TPN），或者更频繁地被考虑进行肠道移植作为其治疗方案的一部分。作者已给予营养因子和特殊饮食的联合治疗，以进一步增强肠道代偿功能，并优化肠衰竭患者的营养吸收。
45名依赖TPN的成年人，其空肠-回肠残余长度≤50cm且有一段连续的结肠，接受生长激素、谷氨酰胺和改良饮食治疗4周，并平均观察1.8年。
患者的平均年龄为43岁，空肠-回肠平均长度为23cm，患者接受TPN的平均时间为4.3年。治疗4周后，26名（58%）患者不再需要TPN支持。良好反应的预测因素包括更长的肠管长度、更低的体重以及更高的肠管长度-体重比。随访时，未接受TPN的患者比例降至40%。
一组原本被认为吸收表面积不足以脱离TPN支持的患者中，约有一半在经过这一肠道康复计划后能够依靠肠内喂养维持自身营养。鉴于长期TPN或肠道移植或两者相关的风险、成本以及生活方式的改变，在开始另一治疗方案之前，对个体患者考虑肠道康复计划似乎是谨慎之举。
