Objective To investigate the role of rehabilitation therapy both on nutritional status and intestinal adaptation of patients with short bowel syndrome (SBS). Methods The literatures about rehabilitation therapy for SBS were reviewed. Results Intestinal rehabilitation refers to the process of restoring enteral autonomy, in order to get rid of parenteral nutrition, usually by means of dietary, medical, and surgical treatment. Recent researches showed that medication and the use of specific nutrients and growth factors could stimulate intestinal absorption and might be useful in the medical management of SBS. Conclusion Intestinal rehabilitation is of benefit in the treatment of SBS and would play a greater role in the future.
Basing on the establishment of an isolated bowel segement (IBS) in Beagle dog by omentoenteropexy, the possibility of using omentum as vascular pedicle in bowel elongation was investigated. Five young Beagle dogs (3 females, 2 males) with a body weight of 5-9 kg were used. A longitudinal incision (15 cm long) was made down to the seromuscular layer of the jejunal segment on the antimesenteric border, 20 cm distal to the duodenojejunal fold, the mucosal layer should never be injured. Then the free margin of the omentum was attached to the seromuscular border of the jejunum by interrupted sutures. One dog died from volvulus and necrosis of the bowel 3 days after operation. Seven weeks later, the mesentery was ligated in one dog and the bowel lengthening procedure was carried out in the other 3 dogs. The procedure consisted of longitudinal splitting of the isolated bowel segment anteroposteriorly, thus two separated segments of bowel were obtained, each received its own blood supply from either omental or mesenteric blood vessels. Either of the longitudinally splitting segments was rebuilt into one intestinal canal by 3/0 non-traumatic sutures. Then isoperistaltic end-to-end anastomosis of these two isolated segments was carried out, and an jejunostomy was established. The free jejunal ends were rejoined together to restore the continuity of the bowel lumen. Two weeks later, the blood supply of the experimental bowel segment was observed. It was shown that the IBS and elongated bowel segment (EBS) appeared viable, and there was good collateral circulation between the bowel segment and the omentum. The regeneration of lymphatics was observed from injection of methylene blue. It was concluded that a viable IBS and EBS could be established by using omentoenteropexy technique. The application of the this model in the management of short bowel syndrome needed to be further investigated.
Objective To investigate the effect and mechanism of growth factors on intestinal compensation after massive intestinal resection， and understand the progress of growth factors in nutrition support treatment for short bowel syndrome （SBS）. Method The related literatures about the application and effect of growth factors in the patients with SBS were reviewed. Results Different kinds of growth factors had different effects on intestinal adaptation after massive intestinal resection. The application of growth factors according to the specific circumstances of the patients with SBS could shorten the residual small intestine compensatory time and improve the nutrition status of the patient with SBS. Conclusions Growth factors play important role in promoting the intestinal adaptation after resection. Different kinds of growth factors have their effects and it’s helpful for getting rid of the total parenteral nutrition early. However， much work still remains to be done.
ObjectiveTo explore a new method for establishing premature piglet model of short bowel syndrome. MethodsThirty two premature piglets were randomly divided into 4 groups, including jejunoileal anastomosis group, jejunocolic anastomosis group, sham operation group, and blank control group. Each group enrolled 8 premature piglets. Jejunoileal anastomosis group:resected 75% of small intestinal, reserved the proximal jejunum (10% of the total small intestine length) and distal ileum (15% of the total small intestine length), with jejunoileal anastomosis. Jejunocolic anastomosis group:removed 75% of the small intestine, including the distal jejunum (25% of the total small intestine length), total ileum (50% of total small intestine length), the ileocecal valve, and the colon beyond 5 cm far from the ileocecal valve, retained the proximal jejunum (25% of the total length of the small intestine), with jejunocolic anastomosis. Sham group:cut off the ileum at a distance of nearly 25 cm of the ileocecal valve ileum, then anastomosed the intestine again. Blank control group:no surgery. Data included the first defecation time, duration of diarrhea and parenteral nutrition (PN) after surgery, the length and weight of the small intestine, the weight of the colon, the villus height and crypt depth of both jejunum and ileum at 21st days postoperatively, were collected and analysed. ResultsCompared with the sham group and blank control group, jejunoileal and jejunocolic anastomosis groups showed higher villus height and the crypt depth of jejunum and ileum (P<0.050), provided enough anatomy evidence of intestinal adaptation. However, the duration of PN in jejunocolic group was longer than in jejunoilea anastomosis group (P<0.050). The length and weight of the small intestine and the weight of colon in jejunocolic anastomosis group, were lower than in jejunoileal anastomosis group (P<0.050), improving that the ability of intestinal adaptation of jejunocolic anastomosis was better than the jejunoileal anastomosis group. ConclusionsPremature piglet models of short bowel syndrome could be established by methods of jejunoileal and jejunocolic anastomosis. Both of the methods had their own different degree of intestinal adaptation and growth. The jejunoileal anastomosis is maybe a better way to establish this model.