Perioperative use of octreotide in gastrointestinal surgery.
Perioperative use of octreotide in gastrointestinal surgery.
复制标题
奥曲肽在胃肠道手术围手术期的使用。
DOI：
10.1159/000201074
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发表时间：
1993
期刊：
影响因子：
3.2
通讯作者：
Mulvihill,SJ
中科院分区：
文献类型：
--
作者：
Mulvihill,SJ
胃肠道内分泌学的发展导致了设计和应用肠肽类似物来治疗疾病。奥曲肽是生长抑素抑制肽的长效类似物，已被证明可用于治疗类癌综合征和VIPoma引起的分泌性腹泻等疾病。最近的经验表明，这种肽在胃肠道手术的某些并发症中的作用。奥曲肽的预防性使用似乎是必要的，在预防类癌综合征的选择性艾德患者进行侵入性手术的类癌危象，并在预防并发症的选择性患者进行胰腺手术。来自安慰剂对照试验的证据支持奥曲肽在严重受影响患者的倾倒症状管理中的作用，至少在短期内。奥曲肽在控制术后胃肠道瘘的排出量方面似乎具有有效的预防作用，并可能加速瘘口的闭合，尤其是在胰瘘中。奥曲肽治疗对回肠造口腹泻和短肠综合征患者有一定疗效，但奥曲肽在控制大便量方面的长期价值尚不清楚。罕见的其他形式的术后分泌性腹泻患者已经完全用奥曲肽治疗。最后，动物和早期人类的经验表明，奥曲肽可能有一个作用，作为一个连续治疗部分小肠梗阻。在大多数情况下，可用的数据是稀疏的，进一步的对照试验是必要的。胃肠道手术后的并发症是罕见的，但可能是严重的。在大多数情况下，没有特定的疗法可用于治疗潜在的病理生理学。奥曲肽是一种天然生长抑素抑制肽的长效类似物，其特性使其在治疗这些疾病中具有潜在的用途。以下综述总结了支持使用的基本原理和可用数据
The evolution of gastrointestinal endocrinology has led to the design and application of analogs of gut peptides to treat disease. Octreotide, a long-acting analog of the inhibitory peptide somatostatin, has proven useful in the manн agement of disorders such as carcinoid syndrome and secretory diarrhea due to VIPoma. More recent experience suggests a role for this peptide in the manн agement of certain complications of gastrointestinal surgery. Prophylactic use of octreotide appears warranted in the prevention of carcinoid crisis in selectн ed patients with carcinoid syndrome undergoing invasive procedures, and in the prevention of complications in selected patients undergoing pancreatic surgery. Evidence from placebo-controlled trials supports a role for octreotide in the management of dumping symptoms in severely affected patients, at least in the short term. Octreotide appears to serve a useful adjunctive role in controlling output from postoperative gastrointestinal fistulae and may hasten closure, particularly in pancreatic fistulae. Selected patients with ileostomy diarrhea and short bowel syndrome benefit from octreotide treatment, but the long-term value of the peptide in controlling stool output is less clear. Rare patients with other forms of postoperative secretory diarrhea have been sucн cessfully treated with octreotide. Finally, animal and early human experience suggests that octreotide may have a role as an adjunctive treatment of partial small bowel obstruction. In most of these conditions, the available data is sparse and further controlled trials are warranted.Complications following gastrointestinal surgery are uncommon, but potentially serious. In most instances, no specific therapy is available to treat the underlying pathoн physiology. Octreotide, the long-acting analog of the natuн rally occurring inhibitory peptide somatostatin, has propн erties which make it potentially useful in the treatment of some of these conditions. The following review summaн rizes the rationale and available data supporting the use