摘要
短肠综合征是各种原因导致小肠广泛切除后,残留功能性小肠过少而出现的临床症候群,治疗难度大,预后较差。多数病人需长期依赖肠外营养提供能量。作为短肠综合征治疗的重要组成部分,肠道非移植手术已有术式的适应证不断被探讨、临床效果不断被验证及新的术式不断被发掘。实践证明,以“小肠倒置术”为代表的“增加食物转运时间”的手术成功率低,改善营养水平有限,已不做推荐。以“缩窄肠管直径、增加残余小肠长度及吸收面积”为核心理念设计的术式如小肠缩窄延长术(LILT)、连续横向肠管成形术(STEP),效果较为确切,是目前应用最多的术式。作为LILT、STEP适应证补充的螺旋延长缩窄术(SILT)是一种最新手术方式,其临床效果仍需进一步验证。
Short bowel syndrome(SBS)is a clinical syndrome after extensive resection of small intestine for various pathogeny,which is difficult to be treated and has a poor prognosis.Most patients need long-term dependence on parenteral nutrition to provide energy for the body.As an important part of the treatment of SBS,the indications of existing intestinal non-transplantation surgery have been continuously discussed,and the clinical effect constantly verified and new surgical methods have been explored.It has been proved that the success rate of existing procedures to improve intestinal transit time represented by"reversed(antiperistaltic)segment"is low,and the improvement of nutritional status is limited,so it is not recommended.The operation designed for the purpose of"narrowing the diameter,increasing the length and absorption area of the residual small intestine"is very effective,and used the most widely at present,such as longitudinal intestinal lengthening and tapering procedure(LILT)and serial transverse enteroplasty(STEP).As the supplement of indications of LILT and STEP,spiral internal lengthening and taping(SILT)is the latest operation method,and its clinical effect still needs to be further verified.
作者
朱长真
王峰
李元新
ZHU Chang-zhen;WANG Feng;LI Yuan-xin(Department of Gastrointestinal Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第5期592-596,共5页
Chinese Journal of Practical Surgery
基金
北京清华长庚医院院内青年基金(No.12020C1003)。
关键词
短肠综合征
非移植手术
小肠缩窄延长术
连续横向肠管成形术
螺旋延长缩窄术
short bowel syndrome
non-transplantation surgery
longitudinal intestinal lengthening and tapering procedure
serial transverse enteroplasty
spiral intestinal lengthening and tapering
