TOTAL PARENTERAL-NUTRITION AS THE SOLE THERAPY IN CROHNS-DISEASE - A PROSPECTIVE-STUDY
TOTAL PARENTERAL-NUTRITION AS THE SOLE THERAPY IN CROHNS-DISEASE - A PROSPECTIVE-STUDY
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DOI：
10.1002/bjs.1800700116
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发表时间：
1983-01-01
影响因子：
9.6
通讯作者：
PICHLMAIER, H
中科院分区：
文献类型：
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作者：
MULLER, JM;KELLER, HW;PICHLMAIER, H
对30例复杂性克罗恩病患者进行了全胃肠外营养(TPN)单独治疗的疗效观察。在插入Broviac中心静脉导管后，患者在医院接受3周的肠外营养，然后在家中再接受9周的营养支持。在此期间，不允许服药或口服。全胃肠外营养(TPN)避免手术25例。这些患者重返工作岗位，饮食正常，不需要医疗支持。5例急性期病情不能控制，行手术切除。TPN期间发生导管相关性脓毒症3例(0.9例/1000d)，导管栓塞2例，4例发生肝内胆汁淤积。17例患者在TPN疗程3~48个月后复发。2年后累积复发率为60%，4年后累计复发率为85%。与本院实施TPN前10年的切除结果相比，TPN后的累积复发率高出4倍。结论：在克罗恩病的治疗中，TPN不是切除的替代选择，应该保留给有多个病灶的患者，因为短肠综合征的风险而不建议手术。
The effect of total parenteral nutrition (TPN) as sole therapy was studied in 30 consecutive cases of complicated Crohn's disease. After insertion of a Broviac-type central venous catheter patients were nourished parenterally for 3 weeks in the hospital and then for an additional 9 weeks at home. During this time no medication or oral intake was allowed. Surgery was avoided in 25 patients by TPN. These patients returned to work, ate normal meals and needed no medical support. In 5 cases it was not possible to control the acute disease and the patients were treated by resection. During TPN, catheter-related sepsis occurred in 3 patients (0·9 cases/1000 days TPN) and catheter embolism in 2. Four other patients developed intrahepatic cholestasis. A relapse of Crohn's disease was observed in 17 cases 3–48 months after the course of TPN. The cumulative recurrence rate is 60 per cent after 2 years and 85 per cent after 4 years. Compared with the results of resection, obtained from a 10-year period before TPN was instituted at our hospital, the cumulative recurrence rate after TPN is four times higher. It is concluded that TPN is not an alternative to resection in the treatment of Crohn's disease and should be reserved for patients with multifocal lesions, when surgery is not advisable because of the risk of a short bowel syndrome.