小児短腸症候群の栄養管理
短腸症候群（short bowel syndrome；以下、SBSと略）は腸管大量切除などにより腸管量が少なくなり消化吸収障害をきたす病態で、先天的または後天的疾患によりその多くが新生児期に発生する。腸管量の減少により水分・電解質の喪失や消化吸収障害をきたすことから、水分・電解質の補充とともに静脈栄養法（parenteral nutrition；以下、PNと略）や経腸栄養法（enteral nutrition；以下、ENと略）を中心とした栄養管理が必須となる。小児SBSでは体重増加不良や成長障害の発生を認めるほか、長期PNに依存する症例では感染症や肝障害などの重篤な合併症をきたしやすい。SBS...
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| Published in | 日本静脈経腸栄養学会雑誌 Vol. 34; no. 1; pp. 11 - 19 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本静脈経腸栄養学会
2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2189-0161 2189-017X |
| DOI | 10.11244/jspen.34.11 |
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| Abstract | 短腸症候群（short bowel syndrome；以下、SBSと略）は腸管大量切除などにより腸管量が少なくなり消化吸収障害をきたす病態で、先天的または後天的疾患によりその多くが新生児期に発生する。腸管量の減少により水分・電解質の喪失や消化吸収障害をきたすことから、水分・電解質の補充とともに静脈栄養法（parenteral nutrition；以下、PNと略）や経腸栄養法（enteral nutrition；以下、ENと略）を中心とした栄養管理が必須となる。小児SBSでは体重増加不良や成長障害の発生を認めるほか、長期PNに依存する症例では感染症や肝障害などの重篤な合併症をきたしやすい。SBSの治療の目標はPNから離脱し経腸の自律（enteral autonomy）を獲得することである。このためには多職種からなる腸管不全対策チームによるリハビリテーションを行い、PNからENへの移行をすすめることが重要である。ここでは小児SBSの病因と予後因子、SBSにおける栄養管理と合併症、腸管延長術など外科的治療を含んだ腸管リハビリテーションについて報告する。 |
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| AbstractList | 短腸症候群（short bowel syndrome；以下、SBSと略）は腸管大量切除などにより腸管量が少なくなり消化吸収障害をきたす病態で、先天的または後天的疾患によりその多くが新生児期に発生する。腸管量の減少により水分・電解質の喪失や消化吸収障害をきたすことから、水分・電解質の補充とともに静脈栄養法（parenteral nutrition；以下、PNと略）や経腸栄養法（enteral nutrition；以下、ENと略）を中心とした栄養管理が必須となる。小児SBSでは体重増加不良や成長障害の発生を認めるほか、長期PNに依存する症例では感染症や肝障害などの重篤な合併症をきたしやすい。SBSの治療の目標はPNから離脱し経腸の自律（enteral autonomy）を獲得することである。このためには多職種からなる腸管不全対策チームによるリハビリテーションを行い、PNからENへの移行をすすめることが重要である。ここでは小児SBSの病因と予後因子、SBSにおける栄養管理と合併症、腸管延長術など外科的治療を含んだ腸管リハビリテーションについて報告する。 |
| Author | 木村, 浩基 米倉, 竹夫 森下, 祐次 山内, 勝治 石井, 智浩 梅田, 聡 |
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Clin Infect Dis 49: 1-45, 2009. 18) Tappenden KA. Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy. JPEN J Parenter Enteral Nutr 38(1 Suppl): 14S-22S, 2014. 23) Carter BA, Cohran VC, Cole CR, et al. Outcomes from a 12-Week, Open-Label, Multicenter Clinical Trial of Teduglutide in Pediatric Short Bowel Syndrome. J Pediatr 181: 102-111. e5, 2017. 42) Bianchi A. Intestinal loop lengthening--a technique for increasing small intestinal length. J Pediatr Surg 15: 145-151, 1980. 30) Wasa M, Takagi Y, Sando K, et al. Long-term outcome of short bowel syndrome in adult and pediatric patients. JPEN J Parenter Enteral Nutr 23(5 Suppl): S110-S112, 1999. 26) 米倉竹夫, 加治 建, 千葉正博 他. 日本小児外科代謝研究会中心静脈カテーテルエタノールロック療法ワーキンググループ. Catheter-Related Blood Stream Infection(CRBSI)に対する中心静脈カテーテルエタノールロック療法(CVC-ELT)の展望. 外科と代謝・栄49: 17-26, 2015. 28) Stout SM, Cober MP. Metabolic effects of cyclic parenteral nutrition infusion in adults and children. Nutr Clin Pract 25: 277-281, 2010. 17) Mayer O, Kerner JA. Management of short bowel syndrome in postoperative very low birth weight infants. Semin Fetal Neonatal Med 22: 49-56, 2017. 22) Garrison AP, Dekaney CM, von Allmen DC, et al. Early but not late administration of glucagon-like peptide-2 following ileo-cecal resection augments putative intestinal stem cell expansion. Am J Physiol Gastrointest Liver Physiol 296: G643-G650, 2009. 34) Olieman JF, Penning C, Ijsselstijn H, et al. Enteral nutrition in children with short-bowel syndrome: current evidence and recommendations for the clinician. J Am Diet Assoc. 110: 420-426, 2010. 3) Javid PJ, Oron AP, Duggan CP, et al. The extent of intestinal failure-associated liver disease in patients referred for intestinal rehabilitation is associated with increased mortality: an analysis of the Pediatric Intestinal Failure Consortium database. J Pediatr Surg 53: 1399-1402, 2018. 39) Gura KM, Lee S, Valim C, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics 121: e678-e686, 2008. 25) Cober MP, Kovacevich DS, Teitelbaum DH. Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. JPEN J Parenter Enteral Nutr 35: 67-73, 2011. 53) D'Antiga L, Goulet O. Intestinal failure in children: the European view. J Pediatr Gastroenterol Nutr 56: 118-126, 2013. 4) Norsa L, Nicastro E, Di Giorgio A, et al. Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children. Nutrients 24; 10(6), 2018. pii: E664. doi: 10.3390/nu10060664. |
| References_xml | – reference: 7) Squires RH, Duggan C, Teitelbaum DH, et al. Pediatric Intestinal Failure Consortium. Natural history of pediatric intestinal failure: initial report from the Pediatric Intestinal Failure Consortium. J Pediatr 161: 723-728, 2012. – reference: 31) Crenn P, Messing B, Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin Nutr 27: 328-339, 2008. – reference: 46) Kaufman SS, Atkinson JB, Bianchi A, et al. American Society of Transplantation. Indications for pediatric intestinal transplantation: a position paper of the American Society of Transplantation. Pediatr Transplant 5: 80-87, 2001. – reference: 28) Stout SM, Cober MP. Metabolic effects of cyclic parenteral nutrition infusion in adults and children. Nutr Clin Pract 25: 277-281, 2010. – reference: 33) Vanderhoof JA, Young RJ. Overview of considerations for the pediatric patient receiving home parenteral and enteral nutrition. Nutr Clin Pract 18: 221-226, 2003. – reference: 47) Burghardt KM, Wales PW, de Silva N, et al. Pediatric intestinal transplant listing criteria - a call for a change in the new era of intestinal failure outcomes. Am J Transplant 15: 1674-1681, 2015. – reference: 32) Fitzgibbons S, Ching YA, Valim C, et al. Relationship between serum citrulline levels and progression to parenteral nutrition independence in children with short bowel syndrome. J Pediatr Surg. 44: 928-932, 2009. – reference: 3) Javid PJ, Oron AP, Duggan CP, et al. The extent of intestinal failure-associated liver disease in patients referred for intestinal rehabilitation is associated with increased mortality: an analysis of the Pediatric Intestinal Failure Consortium database. J Pediatr Surg 53: 1399-1402, 2018. – reference: 10) Spencer AU, Neaga A, West B, et al. Pediatric short bowel syndrome: redefining predictors of success. Ann Surg 242: 403-409, 2005. – reference: 2) Chandra R, Kesavan A. Current treatment paradigms in pediatric short bowel syndrome. Clin J Gastroenterol 11: 103-112, 2018. – reference: 6) Wales PW, de Silva N, Kim J, et al. Neonatal short bowel syndrome: population-based estimates of incidence and mortality rates. J Pediatr Surg 39: 690-695, 2004. – reference: 53) D'Antiga L, Goulet O. Intestinal failure in children: the European view. J Pediatr Gastroenterol Nutr 56: 118-126, 2013. – reference: 19) Barclay AR, Beattie LM, Weaver LT, et al. Systematic review: medical and nutritional interventions for the management of intestinal failure and its resultant complications in children. Aliment Pharmacol Ther 33: 175-184, 2011. – reference: 4) Norsa L, Nicastro E, Di Giorgio A, et al. Prevention and Treatment of Intestinal Failure-Associated Liver Disease in Children. Nutrients 24; 10(6), 2018. pii: E664. doi: 10.3390/nu10060664. – reference: 48) Kappus M, Diamond S, Hurt RT, et al. Intestinal Failure: New Definition and Clinical Implications. Curr Gastroenterol Rep. 18:48. 2016 doi: 10. 1007/s11894-016-0525-x. – reference: 26) 米倉竹夫, 加治 建, 千葉正博 他. 日本小児外科代謝研究会中心静脈カテーテルエタノールロック療法ワーキンググループ. Catheter-Related Blood Stream Infection(CRBSI)に対する中心静脈カテーテルエタノールロック療法(CVC-ELT)の展望. 外科と代謝・栄49: 17-26, 2015. – reference: 49) Grant D, Abu-Elmagd K, Mazariegos G, et al. Intestinal Transplant Association. Intestinal transplant registry report: global activity and trends. Am J Transplant. 15: 210-219, 2015. – reference: 45) Frongia G, Kessler M, Weih S, et al. Comparison of LILT and STEP procedures in children with short bowel syndrome--a systematic review of the literature. J Pediatr Surg 48: 1794-1805, 2013. – reference: 17) Mayer O, Kerner JA. Management of short bowel syndrome in postoperative very low birth weight infants. Semin Fetal Neonatal Med 22: 49-56, 2017. – reference: 23) Carter BA, Cohran VC, Cole CR, et al. Outcomes from a 12-Week, Open-Label, Multicenter Clinical Trial of Teduglutide in Pediatric Short Bowel Syndrome. J Pediatr 181: 102-111. e5, 2017. – reference: 20) Weih S, Kessler M, Fonouni H, et al. Current practice and future perspectives in the treatment of short bowel syndrome in children--a systematic review. Langenbecks Arch Surg 397: 1043-1051, 2012. – reference: 18) Tappenden KA. Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy. JPEN J Parenter Enteral Nutr 38(1 Suppl): 14S-22S, 2014. – reference: 27) Koletzko B, Goulet O, Hunt J, et al. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 41(Suppl 2): S1-S87, 2005. – reference: 37) Oliveira SB, Cole CR. Insights into medical management of pediatric intestinal failure. Semin Pediatr Surg 27: 256-260, 2018. – reference: 25) Cober MP, Kovacevich DS, Teitelbaum DH. Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. JPEN J Parenter Enteral Nutr 35: 67-73, 2011. – reference: 15) Touloukian RJ, Smith GJ. Normal intestinal length in preterm infants. J Pediatr Surg 18: 720-723, 1983. – reference: 9) Fullerton BS, Sparks EA, Hall AM, et al. Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients. J Pediatr Surg 51: 96-100, 2016. – reference: 12) Pakarinen MP, Pakkasjärvi N, Merras-Salmio L, et al. Intestinal rehabilitation of infantile onset very short bowel syndrome. J Pediatr Surg 50: 289-292, 2015. – reference: 13) Capriati T, Giorgio D, Fusaro F, et al. Pediatric Short Bowel Syndrome: Predicting Four-Year Outcome after Massive Neonatal Resection. Eur J Pediatr Surg 28: 455-463, 2018. – reference: 14) Merritt RJ, Cohran V, Raphael BP, et al. Nutrition Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome. J Pediatr Gastroenterol Nutr 65: 588-596, 2017. – reference: 22) Garrison AP, Dekaney CM, von Allmen DC, et al. Early but not late administration of glucagon-like peptide-2 following ileo-cecal resection augments putative intestinal stem cell expansion. Am J Physiol Gastrointest Liver Physiol 296: G643-G650, 2009. – reference: 51) Javid PJ, Malone FR, Reyes J, et al. The experience of a regional pediatric intestinal failure program: Successful outcomes from intestinal rehabilitation. Am J Surg 199: 676-679, 2010. – reference: 24) Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49: 1-45, 2009. – reference: 21) Hartmann B, Johnsen AH, Orskov C, et al. Structure, measurement, and secretion of human glucagon-like peptide-2. Peptides 21: 73-80, 2000. – reference: 43) Kim HB, Lee PW, Garza J, et al. Serial transverse enteroplasty for short bowel syndrome: a case report. J Pediatr Surg 38: 881-885, 2003. – reference: 38) Abi Nader E, Lambe C, Talbotec C, et al. Outcome of home parenteral nutrition in 251 children over a 14-y period: report of a single center. Am J Clin Nutr 103: 1327-1336, 2016. – reference: 1) Diamanti A, Basso MS, Castro M, et al. Irreversible intestinal failure: prevalence and prognostic factors. J Pediatr Gastroenterol Nutr 47: 450-457, 2008. – reference: 44) 増本幸二, 腸管延長術, スタンダード小児外科手術. メディカルビュー社, 東京, 2013, p181-183. – reference: 42) Bianchi A. 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| SubjectTerms | 栄養管理 短腸症候群 腸管リハビリテーション |
| Title | 小児短腸症候群の栄養管理 |
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| ispartofPNX | 日本静脈経腸栄養学会雑誌, 2019, Vol.34(1), pp.11-19 |
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