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Is jejunostomy output nutrient or waste in short bowel syndrome? Experience from six cases

短腸症病人的空腸造口排出物是營養素還是廢棄物?六個病人的經驗

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摘要


背景與目的:術前營養不良的病人術後積極持續靜脈營養是必需的。但是對於接受近端空腸切除而無法馬上吻合的病人需要將近端的空腸外化(exteriorization)形成造口。這些病人通常有因造口液體的高排出量而造成有短腸症的問題。近端空腸造口的排出物(proximal jejunostomy output;PJO)包含豐富的酶和電解質。因此,PJO重新回灌入遠端小腸來維持體內生理的平衡是一條可行途徑,並且評估是否能避免長期依賴靜脈營養(parenteral nutrition;PN)的問題。方法與研究設計:PN在手術後立即開始。當患者開始腸內營養,我們開始了PJO回灌遠端小腸。回灌的技巧需訓練由病人及其照顧者進行,出院後繼續進行。如果可以穩定地進行PJO回灌,PN就停止。結果:病人近端空腸的平均長度為20公分,遠端小腸為77.5公分,6名病人當中3名出院後不需要居家靜脈營養(Home PN);他們只在住院期間需要PN。四名病人6-7個月後成功地進行小腸吻合術,沒有任何營養或代謝並發症。結論:針對有足夠長度的小腸和功能正常的結腸的短腸症病人,進行近端PJO回灌進入遠端小腸可避免長期的PN。

並列摘要


Background and Objectives: Certain patients who undergo proximal jejunum resection are unable to undergoprimary anastomosis and require exteriorization of the proximal jejunum. These patients usually have major problemswith short bowel due to the high output of the stoma. The output of a proximal jejunostomy contains abundantamounts of enzymes and electrolytes. Therefore, it is a feasible approach to re-infuse jejunostomy output toregain homeostasis. To evaluate the effects of proximal jejunostomy output reinfusion into the distal small bowelfor patients with short bowel syndrome, and to determine whether reinfusion could avoid long-term parenteral nutrition(PN). Methods and Study Design: PN was initiated immediately after surgery. When patients started enteralnutrition, we started the proximal jejunostomy output reinfusion protocol. Proximal jejunostomy output reinfusionwas performed by the patients, and continued by them after discharge. When proximal jejunostomy outputreinfusion could be performed stably, PN was stopped. Results: The median length of the proximal jejunum was20 cm and of the distal small bowel was 77.5 cm in patients who could stably receive proximal jejunostomy outputreinfusion alone. Three patients did not require home PN; they only required PN during hospitalization. Fourpatients successfully underwent stoma takedown with intestinal anastomosis after 6-7 months without any nutritionalor metabolic complications. Conclusion: Short bowel syndrome patients with an adequate length of smallbowel and functional colon could avoid long-term PN by receiving reinfusion of proximal jejunostomy output intothe distal small bowel.

被引用紀錄


劉育岑(2019)。一位直腸癌病人行雙側腸造口術後之護理經驗高雄護理雜誌36(1),104-116。https://doi.org/10.6692/KJN.201904_36(1).0010

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