Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica · 2019
[Efficacy of the intestinal rehabilitation program in patients with short bowel syndrome].
СтатьяНазвание и аннотация: Перевод в очереди
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Rodríguez Iglesias P, Domènech Tárreg A B, Driller C, Mangas Álvarez L, Vila Carbó J J
Аннотация
INTRODUCTION: In recent decades, intestinal rehabilitation programs, advances in parenteral nutrition (PN) and intestinal lengthening techniques have improved the results of patients with short bowel syndrome (SBS).
OBJECTIVE: To evaluate the growth, the independence of PN and the survival of patients with SBS diagnosed in the last 12 years.
MATERIAL AND METHOD: Retrospective review between the years 2007-2016. Defining SBS as the inability of the intestine to provide complete absorption via the enteral route being necessary PN. A multivariate analysis was performed to assess the prognostic factors regarding the autonomy of the NE controlled by Cox regression: ileocecal valve presence (qualitative variable: yes/no), small intestine length and gestational age (both quantitative variables).
RESULTS: 18 patients were evaluated. The most frequent causes of SBS: necrotizing enterocolitis (6, 33.3%), jejunal atresia and Hirschsprung (4 cases each pathology, 22.2%) and others (4). The average intestinal length was 51.17 cm at diagnosis, 72.2% lacked an ileocecal valve. The mean PN at the start was 115.8 hours / week, currently: 56.9. The 22.2% achieved complete enteral nutrition (CEN) after an average time of 4.62 years. Serial transverse enteroplasty was performed in 3 patients.The presence of an ileocecal valve was a protective factor to achieve CEN (p<0.018). In contrast, intestinal length and gestational age were not significant. After a follow-up of 5.38 years (3 exitus, 9.6 months on average), no patient was a candidate for intestinal transplantation.
CONCLUSIONS: The survival of patients with SBS has improved in recent decades due to intestinal rehabilitation programs, advances in PN and intestinal lengthening techniques. It is possible to achieve NEC and avoiding intestinal transplantation.
OBJECTIVE: To evaluate the growth, the independence of PN and the survival of patients with SBS diagnosed in the last 12 years.
MATERIAL AND METHOD: Retrospective review between the years 2007-2016. Defining SBS as the inability of the intestine to provide complete absorption via the enteral route being necessary PN. A multivariate analysis was performed to assess the prognostic factors regarding the autonomy of the NE controlled by Cox regression: ileocecal valve presence (qualitative variable: yes/no), small intestine length and gestational age (both quantitative variables).
RESULTS: 18 patients were evaluated. The most frequent causes of SBS: necrotizing enterocolitis (6, 33.3%), jejunal atresia and Hirschsprung (4 cases each pathology, 22.2%) and others (4). The average intestinal length was 51.17 cm at diagnosis, 72.2% lacked an ileocecal valve. The mean PN at the start was 115.8 hours / week, currently: 56.9. The 22.2% achieved complete enteral nutrition (CEN) after an average time of 4.62 years. Serial transverse enteroplasty was performed in 3 patients.The presence of an ileocecal valve was a protective factor to achieve CEN (p<0.018). In contrast, intestinal length and gestational age were not significant. After a follow-up of 5.38 years (3 exitus, 9.6 months on average), no patient was a candidate for intestinal transplantation.
CONCLUSIONS: The survival of patients with SBS has improved in recent decades due to intestinal rehabilitation programs, advances in PN and intestinal lengthening techniques. It is possible to achieve NEC and avoiding intestinal transplantation.