Short Bowel Syndrome : 長期追跡観察からみた問題点とその対策(I 主要疾患の遠隔成績, 25周年記念シンポジウム論文)

抄録

Long-term survival after massive intestinal resection is now possible with parenteral and enteral nutrition. However, infants and children with short bowel syndrome incidentally suffer a number of difficulties and / or complications during their long lives after catch-up growth. This paper discusses the adjunct surgical procedures for the short bowel syndrome, and presents the considerations on how to cope with the difficulties and / or complications through the experiences of seventeen long-term survivals at Juntendo University Hospital for the last two decades, whose present ages range from 2 to 21 years old. Adjunct procedures for the short bowel syndrome are mainly divided into three groups; the first is to prevent intestinal resection and conserve the intestine by the second-look operation when massive resection is necessary, the second is to slow intestinal transit by antiperistaltic segments, colon interposition, intestinal valves and sphincters, recirculating loops and intestinal pacing, and the third is to increase the area of absorption by intestinal tapering or lengthening, growing neomucosa and intestinal transplantation. Among these surgical procedures, the second-look operation actually prevents intestinal resection and conserves the intestine, antiperistaltic segments, colon interposition, and intestinal valves may benefit patients with sufficient absorption area but rapid intestinal transit and intestinal tapering or lengthening may benefit selected patients with dilated bowel segments. However, growing neomucosa is not yet clinically efficacious, and the intestinal transplantation still remains unsatisfactory in spite of recent advances in immunosuppressants. The difficulties and complications observed in the 17 patients during their lives were as follows; growth retardation "stunting" caused by chronic protein energy malnutrition, adhesive ileus or stagnant loop syndrome due to the initial surgical procedure including the second-look operation, cholelithiasis, bone disorders such as rickets, fatsoluble vitamins and vitamin B_<12> deficiencies, urinary oxalocaliculi and rapidly falling serious dehydration associated with incidental diarrhea. However, most of these difficulties and complications would be prevented if the managements would be carefully continued for long-term even after catch-up growth. The most important is continued nutritional cares in the patients with massive intestinal resection.