Grebeldinger S, Marinković S
Institut za zdravstvenu zastitu dece i omladine, Medicinski fakultet, Novi Sad.
Med Pregl. 1998 Sep-Oct;51(9-10):405-9.
Long-term survival after massive intestinal resection is now possible with parenteral nutritional support. The expense, morbidity, and inconvenience of this therapy, however, have led to continued interest in alternatives for the treatment of the short bowel syndrome. Patients with short bowel require a multi disciplinary approach over a prolonged period. HISTORICAL CONSIDERATIONS: The history of small bowel transplantation started in 1959 when Lillehei showed that autotransplantation of the small intestine in a dog was feasible. From 1964 to 1971, 7 attempts of small bowel allotransplantations in humans have been reported. All 7 patients died.
Short gut syndrome is a malabsorptive condition occurring after significant loss of intestinal absorptive capacity. The clinical syndrome is manifested by malnutrition, steatorrhea, weight loss, and diarrhea due to decreased absorptive capacity.
Etiologic factors leading to the short gut state include necrotizing enterocolitis, midgut volvulus, trauma, embolic phenomenon, and Crohn's disease.
Intestinal failure is the end result of several complex interacting mechanisms related to: reduced enterocyte mass, short small bowel length with consequent reduced mucosal contact time for absorption, massive proximal loop dilatation with poor propulsion, and intraluminal stasis and bacterial overgrowth lead to bacterial translocation to the liver systemically.
Patients with short bowel must be totally or partly supported with intravenous nutrition until enteral absorption can sustain survival and growth. Autologous bowel reconstruction attempts to reconfigure the residual bowel to eliminate negative factors of bowel dilatation and stasis, and redistribute the absorptive mucosa to enhance the adaptation response. Several procedures have been suggested to: prolong transmitting time and increase mucosal contact time, enhance absorption by bowel tailoring and bowel lengthening, and increasing the Enterocyte mass.
Autologous gastro-intestinal reconstruction is still in its infacny with prospect of new and different concepts for the future.
通过肠外营养支持，大面积肠道切除术后实现长期存活现已成为可能。然而，这种治疗方法的费用、发病率和不便之处，使得人们持续关注短肠综合征治疗的替代方案。短肠患者需要长期的多学科治疗方法。
小肠移植的历史始于1959年，当时利尔黑证明狗的小肠自体移植是可行的。1964年至1971年期间，有报道称进行了7例人类小肠同种异体移植尝试。所有7例患者均死亡。
短肠综合征是一种在肠道吸收能力显著丧失后出现的吸收不良状况。临床综合征表现为营养不良、脂肪泻、体重减轻以及因吸收能力下降导致的腹泻。
导致短肠状态的病因包括坏死性小肠结肠炎、中肠扭转、创伤、栓塞现象和克罗恩病。
肠道衰竭是几种复杂相互作用机制的最终结果，这些机制包括：肠细胞数量减少、小肠长度缩短导致吸收的黏膜接触时间减少、近端肠袢大量扩张且推进功能差，以及肠腔内淤滞和细菌过度生长导致细菌全身转移至肝脏。
短肠患者必须完全或部分通过静脉营养支持，直到肠道吸收能够维持生存和生长。自体肠道重建试图重新配置残余肠道，以消除肠道扩张和淤滞的负面因素，并重新分布吸收性黏膜以增强适应性反应。已提出几种手术方法来：延长传输时间并增加黏膜接触时间、通过肠道剪裁和肠道延长增强吸收，以及增加肠细胞数量。
自体胃肠重建仍处于起步阶段，未来有望出现新的不同概念。
