Jeppesen P B, Staun M, Mortensen P B
Dept. of Medicine CA, Rigshospitalet, University of Copenhagen, Denmark.
Scand J Gastroenterol. 1998 Aug;33(8):839-46. doi: 10.1080/00365529850171503.
Small-bowel transplantation is an alternative to home parenteral nutrition (HPN) in patients with gut failure. Our aim was to report the indication, diagnosis, morbidity, mortality, and intestinal adaptation in the total cohort of Danish patients receiving HPN at any time during the 5 years between 1 January 1991 and 31 December 1995. The data were analysed against the option of transplantation.
HPN was given to 129 patients; 59 (46%) had inflammatory bowel disease (15% died), 26 (20%) had cured cancers (42% died), and 44 (34%) had other diseases (dysmotility, surgical complications, infarcts, and so forth; 27% died). Of these, 60% were new in the HPN program, but only 19% received HPN all 5 years; 31 % had terminated HPN, 19% permanently, and 25% died. Only four deaths were HPN-related. In December 1995, 73 patients were receiving HPN in Denmark, for a prevalence of 13.9 per million, which is the highest in Europe but 10-fold lower than in the United States.
Gut failure was the only indication for HPN in Denmark. Weight loss without gut failure, such as disseminated cancer and acquired immunodeficiency syndrome, was not an indication for HPN. Survival after small-bowel transplantation should be assessed against a sizeable mortality among candidates receiving HPN, and this depends on diagnosis and age. In an HPN population comparable with the Danish, a quarter is likely to die within a period of 5 years, a quarter will terminate HPN, and the others survive with HPN. Small-bowel transplantation can be a lifesaving procedure in the small fraction of foreseeable HPN-related deaths, mainly caused by liver failure. Transplantation will not improve survival in most adult HPN patients, and only an improved quality of life after transplantation justifies this procedure in most HPN patients.
对于肠道衰竭患者，小肠移植是家庭肠外营养（HPN）的一种替代方案。我们的目的是报告1991年1月1日至1995年12月31日这5年间丹麦任何时候接受HPN治疗的所有患者的适应症、诊断、发病率、死亡率及肠道适应性情况，并针对移植这一选择对数据进行分析。
129例患者接受了HPN治疗；59例（46%）患有炎症性肠病（15%死亡），26例（20%）患有已治愈的癌症（42%死亡），44例（34%）患有其他疾病（动力障碍、手术并发症、梗死等；27%死亡）。其中，60%是HPN项目中的新患者，但仅19%在整个5年期间都接受HPN治疗；31%终止了HPN治疗，19%为永久性终止，25%死亡。仅4例死亡与HPN相关。1995年12月，丹麦有73例患者接受HPN治疗，患病率为每百万人口13.9例，这是欧洲最高的，但比美国低10倍。
在丹麦，肠道衰竭是HPN的唯一适应症。无肠道衰竭的体重减轻，如播散性癌症和获得性免疫缺陷综合征，不是HPN的适应症。小肠移植后的生存率应与接受HPN治疗的候选者中相当高的死亡率进行比较，而这取决于诊断和年龄。在与丹麦情况相当的HPN人群中，四分之一可能在5年内死亡，四分之一将终止HPN治疗，其余患者继续接受HPN治疗存活。小肠移植在一小部分可预见的主要由肝功能衰竭导致的与HPN相关的死亡中可能是一种挽救生命的手术。移植不会提高大多数成年HPN患者的生存率，在大多数HPN患者中，只有移植后生活质量的改善才使这一手术合理。
