Clinical-nutritional autonomy is the ultimate goal of patients with intestinal failure(IF).Traditionally,patients with IF have been relegated to lifelong parenteral nutrition(PN)once surgical and medical rehabilitatio...Clinical-nutritional autonomy is the ultimate goal of patients with intestinal failure(IF).Traditionally,patients with IF have been relegated to lifelong parenteral nutrition(PN)once surgical and medical rehabilitation attempts at intestinal adaptation have failed.Over the past two decades,however,outcome improvements in intestinal transplantation have added another dimension to the therapeutic armamentarium in the field of gut rehabilitation.This has become possible through relentless efforts in the standardization of surgical techniques,advancements in immunosuppressive therapies and induction protocols and improvement in postoperative patient care.Four types of intestinal transplants include isolated small bowel transplant,liver-small bowel transplant,multivisceral transplant and modified multivisceral transplant.Current guidelines restrict intestinal transplantation to patients who have had significant complications from PN including liver failure and repeated infections.From an experimental stage to the currently established therapeutic modality for patients with advanced IF,outcome improvements have also been possible due to the introduction of tacrolimus in the early 1990s.Studies have shown that intestinal transplant is cost-effective within 1–3 years of graft survival compared with PN.Improved survival and quality of life as well as resumption of an oral diet should enable intestinal transplantation to be an important option for patients with IF in addition to continued rehabilitation.Future research should focus on detecting biomarkers of early rejection,enhanced immunosuppression protocols,improved postoperative care and early referral to transplant centers.展开更多
目的：探讨短肠综合征合并肠外瘘的临床特点与治疗方法。方法选择2008年1月至2015年12月普外科收治的剩余小肠＜105 cm 的肠外瘘患者36例，对其肠外瘘发生部位、原因、治疗方法和肠康复方法进行回顾性分析。结果36例中治愈23例，死亡4例...目的：探讨短肠综合征合并肠外瘘的临床特点与治疗方法。方法选择2008年1月至2015年12月普外科收治的剩余小肠＜105 cm 的肠外瘘患者36例，对其肠外瘘发生部位、原因、治疗方法和肠康复方法进行回顾性分析。结果36例中治愈23例，死亡4例，9例好转后中断治疗出院。患者肠管残存长度为（61.05±28.60）cm。31例接受肠内营养，其中10例未接受肠康复治疗，肠管长度为（53.30±31.60）cm，肠内营养恢复时间为（131.50±91.20）d；21例接受肠康复治疗，肠管长度为（63.60±20.50）cm，肠内营养恢复时间为（60.10±49.80）d。结论短肠综合征并肠外瘘的主要疾病为肠扭转、肠坏死，肠瘘部位多在吻合口，因肠坏死范围较广，手术切除界限不易判断。早期应用生长抑素能够减少消化液分泌的作用，同时能够减少短肠综合征急性期的腹泻及电解质紊乱症状。后期应用生长抑素能促进肠外瘘自愈和肠康复的双重作用。展开更多
文摘Clinical-nutritional autonomy is the ultimate goal of patients with intestinal failure(IF).Traditionally,patients with IF have been relegated to lifelong parenteral nutrition(PN)once surgical and medical rehabilitation attempts at intestinal adaptation have failed.Over the past two decades,however,outcome improvements in intestinal transplantation have added another dimension to the therapeutic armamentarium in the field of gut rehabilitation.This has become possible through relentless efforts in the standardization of surgical techniques,advancements in immunosuppressive therapies and induction protocols and improvement in postoperative patient care.Four types of intestinal transplants include isolated small bowel transplant,liver-small bowel transplant,multivisceral transplant and modified multivisceral transplant.Current guidelines restrict intestinal transplantation to patients who have had significant complications from PN including liver failure and repeated infections.From an experimental stage to the currently established therapeutic modality for patients with advanced IF,outcome improvements have also been possible due to the introduction of tacrolimus in the early 1990s.Studies have shown that intestinal transplant is cost-effective within 1–3 years of graft survival compared with PN.Improved survival and quality of life as well as resumption of an oral diet should enable intestinal transplantation to be an important option for patients with IF in addition to continued rehabilitation.Future research should focus on detecting biomarkers of early rejection,enhanced immunosuppression protocols,improved postoperative care and early referral to transplant centers.
文摘目的：探讨短肠综合征合并肠外瘘的临床特点与治疗方法。方法选择2008年1月至2015年12月普外科收治的剩余小肠＜105 cm 的肠外瘘患者36例，对其肠外瘘发生部位、原因、治疗方法和肠康复方法进行回顾性分析。结果36例中治愈23例，死亡4例，9例好转后中断治疗出院。患者肠管残存长度为（61.05±28.60）cm。31例接受肠内营养，其中10例未接受肠康复治疗，肠管长度为（53.30±31.60）cm，肠内营养恢复时间为（131.50±91.20）d；21例接受肠康复治疗，肠管长度为（63.60±20.50）cm，肠内营养恢复时间为（60.10±49.80）d。结论短肠综合征并肠外瘘的主要疾病为肠扭转、肠坏死，肠瘘部位多在吻合口，因肠坏死范围较广，手术切除界限不易判断。早期应用生长抑素能够减少消化液分泌的作用，同时能够减少短肠综合征急性期的腹泻及电解质紊乱症状。后期应用生长抑素能促进肠外瘘自愈和肠康复的双重作用。
