Intestinal failure and small bowel transplantation, including clinical nutrition: Working Group Report of the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition
Intestinal failure and small bowel transplantation, including clinical nutrition: Working Group Report of the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition
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DOI：
10.1097/00005176-200406002-00012
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发表时间：
2004-01-01
影响因子：
2.9
通讯作者：
Ohtsuka, Y
中科院分区：
文献类型：
--
作者：
Kocoshis, SA;Beath, SV;Ohtsuka, Y
虽然肠衰竭可以用过多的粪便能量损失来定义，但更广泛接受的定义是“胃肠道无法自主维持生命（1）。肠衰竭患者的很大一部分营养必须通过肠外途径输送。大多数肠衰竭患者患有解剖学短肠综合征。少数人有无功能的肠道。肠衰竭给人类带来巨大的痛苦和巨大的经济资源支出。一项基于奥利基金会全肠外营养（TPN）数据库的调查据估计，1992 年，大约有 40 000 名北美患者接受慢性家庭肠外营养 (2)。 20 世纪 90 年代，接受 TPN 治疗的成人患者的平均每日支出超过 1000 美元 (2)，即使在墨西哥这样的发展中国家，每年的短肠综合征手术费用也高达 50 000 美元 (3)。 15-20% 的慢性 TPN 患者最终可能需要小肠移植，估计每位患者的费用约为 20 万至 30 万美元 (4)，这超出了许多患者的承受能力。出于所有这些原因，我们必须做出重大努力，更好地了解肠衰竭和短肠综合征的流行病学，我们必须采取策略来减少肠衰竭的发生率，降低肠移植的成本并提高其可用性，并进一步加强基础和治疗。短肠综合征非移植疗法的转化研究将受益于对肠道衰竭和与 TPN 相关的肠道衰竭并发症的额外教育。在病人护理中。
Although intestinal failure can be defined by excessive fecal energy loss, a more widely accepted definition is "the inability of the gastrointestinal tract to sustain life autonomously (1). A substantial percentage of the nutrition of patients with intestinal failure must be delivered parenterally. Most patients with intestinal failure have anatomic short bowel syndrome. A lesser number have a nonfunctional intestinal tract. Intestinal failure produces great human suffering and prodigious expenditures of economic resources. A Survey based on the Oley Foundation database on total parenteral nutrition (TPN) estimated that, in 1992, approximate to40 000 North American patients were receiving chronic home parenteral nutrition (2). The average daily expenditure for adult TPN-bound patients in the 1990s was more than US $ 1000 (2). Even in a developing country such as Mexico, the annual cost Of surgical short bowel syndrome averaged US $50 000 (3). Such costs are prohibitive for the vast majority of the world's population. Approximately 15-20% of patients on chronic TPN may ultimately require a small intestinal transplant, which is estimated to cost about US $200 000 to $300 000 per patient (4). This is beyond the reach of many patients.For all of these reasons, significant efforts must be made to better understand the epidemiology of intestinal failure and short bowel syndrome. We Must implement strategies to reduce the incidence of intestinal failure, to lower the cost of intestinal transplantation and to improve its availability, and to further basic and translational research on nontransplantation therapies of short bowel syndrome. General physicians and surgeons who take care of children will benefit from additional education in the recognition of intestinal failure and of TPN-related complications of intestinal failure. Finally, development of cadres of superspecialized gastroenterologists and Surgeons who are experts in all phases of nutritional rehabilitation, including medical management of intestinal failure, nontransplantation surgical therapies, and small intestinal transplantation, is essential. Only with proper education of all members of the healthcare team can ongoing advances in research be translated into improvements in patient care.