先天性小肠闭锁中卡哈尔间质细胞神经节细胞分布的研究

目的 了解卡哈尔间质细胞和神经节细胞在先天性小肠闭锁中的分布情况并探讨其意义。方法 应用免疫组化SP法检测16例先天性小肠闭锁患儿肠壁内c-kit和NSE的表达情况,并以正常小肠标本作为对照。结果c-kit和NSE阳性表达闭锁组明显低于对照组(P<0.05)。在闭锁近端,距盲端11cm处卡哈尔细胞分布接近正常,距盲端8 cm处神经节细胞分布接近正常;闭锁远端距盲端2 cm处卡哈尔细胞接近正常。结论 小肠闭锁近端肠壁内卡哈尔细胞和神经节细胞的减少可能影响肠道的蠕动,导致术后肠道功能不良。     

骨髓间充质干细胞对大鼠生精上皮不同照射剂量放射性损伤的修复作用

目的研究大鼠骨髓间充质干细胞的分离培养方法，建立大鼠生精上皮放射性损伤动物模型，观察骨髓间充质干细胞对大鼠生精上皮放射性损伤的修复作用。方法体外培养大鼠骨髓间充质干细胞，建立大鼠放射性损伤动物模型。高剂量（2Gy）放射线照射组Wister大鼠20只，低剂量（0．5Gy）放射线照射组Wister大鼠20只，各组中随机取10只移植骨髓间充质干细胞作为实验组，剩余未移植大鼠10只作为对照组。取10只为经放射线照射大鼠作为正常对照组。照射2周和4周后取大鼠睾丸，切片染色镜下观察。结果高剂量照射组较低剂量照射组大鼠睾丸组织损伤明显加重，低剂量照射组实验组大鼠睾丸组织于移植后两周各级生精细胞基本恢复正常，移植后4周完全恢复与正常未照射组无明显区别。高剂量照射组实验组大鼠睾丸组织于移植后两周管腔内可见少量各级生精细胞，移植后4周管腔内各级生精细胞增多，可见成熟精子。各实验组恢复均好于对照组。结论大鼠骨髓间充质干细胞对生精上皮放射性损伤的修复可起重要作用。     

The thrombin antagonist hirudin fails to inhibit endotoxin-induced leukocyte/endothelial cell interaction and microvascular perfusion failure

Besides its central role in coagulatory pathways, thrombin is known to be a key mediator of macrophage and granulocyte activation in vitro. During recent years the concept of thrombin inhibition by the specific thrombin inhibitor, hirudin, has been established to treat septic disorders. Since basic mechanisms of sepsis include leukocyte/endothelial cell interaction and deterioration of capillary perfusion, we hypothesized that hirudin modulates leukocyte activation and microvascular injury. Severe endotoxemia was induced in Syrian hamsters by intravenous administration of endotoxin (lipopolysaccharide [LPS], E. coli, 2mg/kg) at 0 h. Hirudin (0.25 mg/kg/h) was substituted intravenously during the 4 h after the induction of endotoxemia (n = 7, hirudin). In control animals (n = 6, control) LPS was given without hirudin substitution. In skinfold chamber preparations leukocyte/endothelial cell interaction and functional capillary density (FCD, measure of capillary perfusion) were analyzed during a 24-h period after LPS injection using intravital fluorescence microscopy. Hirudin effectively normalized thromboplastin time and antithrombin activity when compared to controls (P < 0.05, ANOVA). However, hirudin did not attenuate LPS-induced arteriolar and venular leukocyte adherence, and even tended to increase leukocyte adherence after 24 h (P > 0.05, MANOVA). In parallel, addition of hirudin led to a significant deterioration of FCD over time when compared to controls (hirudin: baseline = 171 +/- 19 cm(-1) versus 16 +/- 9 at 24 h; control: baseline = 150 +/- 20 cm(-1) versus 62 +/- 18 at 24 h; P < 0.05). The fall in FCD in hirudin animals was associated with a significant increase of wet-to-dry weight ratios in lung, kidney, muscle, and small intestine (P < 0.05 versus control, ANOVA). Thus our study does not indicate a protective effect of hirudin on microcirculation during endotoxemia, despite an improvement of coagulatory parameters. This result may at least in part explain the lack of efficacy of hirudin on lethality during endotoxemia and sepsis.     

大鼠脊髓损伤后P物质与神经源性肠道功能障碍的关系

目的探讨脊髓损伤后结肠中P 物质与神经源性肠道功能障碍的关系。方法60 只体质量(220±40) g 的雄性Sprague-Dawley 大鼠随机分为假手术组(n=20)、正常对照组(n=20)和模型组(n=20)。氯胺酮60 mg/kg 腹腔注射麻醉大鼠,利用NYU脊髓打击器,以75 g &#8901;cm致伤力制作T10脊髓损伤模型,分别于造模后24 h、1 周、3 周和5 周时切除大鼠结肠组织制作标本,检测肠道传输功能,采用ELISA 方法测定血清中和组织中的P 物质含量,实时荧光定量PCR和Western blotting 法检测P 物质mRNA和蛋白表达。结果模型组大鼠脊髓损伤后出现肠道传输功能下降,且于造模后3 周时肠道传输达到最低值;造模后3 周时模型组血清和组织中P 物质含量与假手术组相比均降低,结肠组织中P 物质的mRNA及蛋白表达水平也下调,与假手术组、正常对照组相比具有显著性差异,假手术组P 物质的表达是模型组的(3.12±0.51)倍(P<0.05)。结论大鼠脊髓损伤后神经源性肠道功能障碍与结肠中P物质的表达降低有关。     

猪小肠黏膜下层作为组织工程肌腱支架的强度

背景:小肠黏膜下层是一种能够适合于细胞迁移、生长和增殖的良好的支架材料,已被应用于组织工程研究。目的:分析猪小肠黏膜下层作为组织工程肌腱支架的可行性。方法:将24只左腿屈趾肌腱缺损罗曼鸡随机分组,实验组于缺损处植入猪小肠黏膜下层与鸡胚趾深屈肌肌腱细胞复合物,对照组于缺损处植入单纯猪小肠黏膜下层,植入后3,6,9周检测两组植入材料肌腱最大拉伸强度。结果与结论:植入后第3周时,实验组和对照组植入材料肌腱最大拉伸强度差异无显著性意义。植入后第6,9周时,实验组植入材料肌腱最大拉伸强度高于对照组(P<0.05)。表明肌腱细胞-小肠黏膜下层材料复合构建的组织工程肌腱力学强度强于单纯小肠黏膜下层材料修复肌腱,可作为组织工程肌腱支架材料。     

LigaSure 在犬肠道闭合手术中的应用评价

【目的】探讨 LigaSure 在犬肠道闭合手术中的应用价值。【方法】随机将20只犬分为使用 Li-gaSure 进行肠道闭合术的实验组和使用传统手工肠道闭合术的对照组,根据其闭合的部位不同再将实验组和对照组分为小肠和大肠两个亚组,每组5只。比较两组肠道闭合时间、术中出血量、术后并发症发生率及闭合处肠道的组织结果的变化。【结果】试验组肠道闭合时间小肠为3 s,大肠7 s;对照组肠道闭合时间小肠为(8±2.2)min,大肠为(12±1.2)min。试验组小肠和大肠术中无明显出血(出血量为0 mL),对照组术中出血量小肠为(27±2.86)mL,大肠为(29.65±3.24)mL。上述指标两组间比较差异均具有统计学意义(P <0.05)。两组并发症发生率比较差异无显著性(P >0.05)。【结论】LigaSure 闭合肠道效果可靠,能减少手术时间、肠道闭合时间及术中出血量,且未见明显术后并发症,值得临床进一步研究。     

Ileus following radiotherapy: importance and therapeutic aspects of surgery for late radiation injuries of the intestine

Between 1971 and 1988 74 operations for intestinal complications following radiotherapy were performed on 67 patients at the Second Surgical Department, University of Vienna. The lesions were located in the small bowel (n = 41) and in the sigmoid colon/rectum (n = 33). 98.5% of the patients were females, the most frequent cause for irradiation being ovarian cancer. Bowel stenosis with resultant chronic or acute ileus was the most frequent indication for operation, occurring in 31 cases (76%) of the small bowel lesions and in 15 cases (46%) of the colon lesions. Percutaneous irradiation resulted in a significantly higher proportion of small bowel lesions (77%, p = 0.001), whilst endocavitary irradiation was followed in 67% of cases by colorectal lesions. Different application modality of irradiation also resulted in completely different symptoms for small and large bowel lesions. The operative mortality was 9.5%. Peritonitis following anastomotic leakage was the cause of death in 6 of 7 cases. In the treatment of small bowel ileus mortality following bowel resection (9%, one of 11 cases) was comparable to that of the bypass operation (6%, one of 18 cases). Both operation methods seem to be justified. Single-layer anastomosis resulted in zero mortality in 21 cases of ileus operated on by this technique, compared with 19% mortality in 16 cases treated by double-layer anastomosis and should be preferred for operations on the irradiated bowel.     

Ultrasonography as a primary diagnostic tool in patients with inflammatory disease and tumors of the small intestine and large bowel

In 240 patients with predefined indications, the validity of ultrasound imaging as a primary diagnostic procedure was examined prospectively. Ultrasonography revealed normal intestinal findings in 150 patients and pathological lesions in 90 subjects. All patients underwent subsequent endoscopic, radiological, or surgical examination. In 7 patients with Crohn's disease and in 2 patients with radiation colitis, the ultrasound findings were false-negative. In the other 9 cases, ultrasonography suggested false-positive results. Ultrasonographic examination of the small intestine and large bowel had a very high overall validity, with a sensitivity of 90% and specificity of 94%. © 1994 John Wiley & Sons, Inc.     

肠道弥漫性大B细胞淋巴瘤患者的临床病理特征分析

目的:探讨肠道弥漫性大B细胞淋巴瘤(DLBCL)的临床病理特征。方法:回顾性分析2007年1月至2014年10月在山东第一医科大学附属济南人民医院确诊的136例DLBCL患者的临床特点、病理形态、免疫表型及EBER原位杂交等资料。共获取136例肿瘤样本,根据肿瘤部位分为十二指肠23例,回盲部63例,其他小肠29例,直肠7例和其他大肠14例。采用Kaplan-Meier法绘制生存曲线并行Log-rank检验。结果:与肠道其他部位比较,回盲部和十二指肠以外的小肠部位的DLBCL患者主要为男性(P=0.042),国际预后指数较低(P=0.001),局限期肿瘤占比较高(P=0.015);回盲部乳酸脱氢酶升高的发生率更高(P=0.007),肠梗阻或穿孔率更高(P<0.001)。回盲部及其他小肠部位的DLBCL患者的5年总生存率、5年无进展生存率高于其他部位,但比较差异无统计学意义(P=0.135,0.459)。50%肠道DLBCL为生发中心B细胞样亚型。136例肿瘤样本中低度恶性B细胞淋巴瘤占比为21%,回盲部及其他小肠标本均占低度恶性B细胞淋巴瘤的29%,与其他部分比较差异有统计学意义(P=0.025)。136例DLBCL肿瘤样本中约16%表达滤泡性淋巴瘤,无黏膜相关淋巴组织淋巴瘤表型表达。十二指肠DLBCL的EBER1阳性率明显高于其他部位(5/23,22%vs 2/63,3%,P=0.001)。结论:肠道DLBCL以男性为主,回盲部为最常见的发病部位。回盲部和十二指肠以外的小肠DLBCL患者国际预后指数低,局限期肿瘤比例高,乳酸脱氢酶水平低,肠梗阻或穿孔的发生率高,惰性淋巴瘤发生率低。十二指肠DLBCL的EBER1阳性率较高。     

胶囊内镜对86例患者小肠疾病的诊断分析

目的：分析评价胶囊内镜对小肠疾病的诊断价值。方法：对86例怀疑有小肠疾病的患者行胶囊内镜检查,并分析检查结果。结果：共检出小肠病变48例（55.8%）。其中小肠血管发育异常17例,小肠绒毛萎缩10例,小肠息肉5例,小肠溃疡3例,小肠炎症8例,小肠隆起性病变2例,小肠钩虫病1例,疑似炎症性肠病1例,末端回肠炎症伴回盲部占位1例。不明原因消化道出血23例中,检查出小肠病变19例,阳性率82.6%,其中小肠血管发育异常或伴活动性出血11例,小肠溃疡3例,钩虫病1例,小肠息肉3例,小肠多发隆起灶1例。胶囊内镜正常电池范围内对小肠检查情况：86例中有14例未能完成抵达回盲部,占16.3%。但其中10例已经发现小肠病变。结论：胶囊内镜对小肠疾病诊断率高,尤其适用于不明原因的消化道出血患者。     

白细胞介素11防治大鼠大剂量甲氨蝶呤致黏膜炎的实验研究

目的　观察白细胞介素 11(IL 11)防治大剂量甲氨蝶呤 (HDMTX)致Wistar大鼠小肠黏膜炎的疗效及IL 11对HDMTX抑制人T淋巴细胞白血病细胞系CEM增殖作用的影响。方法　Wistar大鼠腹腔注射MTX 1ml(10 0mg/kg) ,同时皮下注射IL 114 75 μg·kg-1·d-1(大剂量 )或 15 0 μg·kg-1·d-1(小剂量 ) ,分 2次 ,共 2d ;同时设生理盐水对照组及单独注射MTX对照组。各组大鼠于MTX注射后第1,3,5 ,7天处死 ,观察各组大鼠死亡率、小肠组织形态学及超微结构变化以及小肠隐窝细胞增殖细胞核抗原 (PCNA)变化情况。MTT法观察不同浓度IL 11对CEM细胞增殖的影响及对HDMTX抑制作用的影响。结果　在体内 ,IL 11可明显降低小肠组织病理学积分 ,增加小肠绒毛的高度 ,增加绒毛高度/隐窝深度的比值 ,促进小肠隐窝细胞核的增殖 ,使实验鼠死亡率下降。IL 11预防治疗组效果最好 ,与MTX对照组比较 ,差异有统计学意义 (P <0 .0 1)。在体外 ,IL 11对CEM细胞的增殖及HDMTX的抑瘤作用无明显影响。结论IL 11可以明显减轻HDMTX诱发的小肠黏膜炎的严重程度 ,缩短病程 ,提高实验动物的存活率 ,IL 11可以安全地用于儿童急性淋巴细胞白血病HDMTX的化疗。     

Tissue oxygenation in hemorrhagic shock measured as transcutaneous oxygen tension, subcutaneous oxygen tension, and gastrointestinal intramucosal pH in pigs

BACKGROUND AND METHODS: Tissue oxygenation, measured in peripheral tissue as transcutaneous PO2 (PtCO2) and subcutaneous PO2, was compared with the oxygenation in GI mucosa, which was measured as intramucosal wall pH (pHi), during experimental hemorrhagic shock and resuscitation in pigs. The pigs were hemorrhaged stepwise to a BP of 80 and 45 mm Hg, followed by retransfusion. PtCO2 was measured in the groin and subcutaneous PO2 was measured in the hip region. Intraluminal PCO2 was measured in the stomach, in the small intestine, and the sigmoid colon using silicone catheters. A simultaneous determination of arterial blood HCO3 concentration allowed pHi to be calculated using Henderson-Hasselbalch equation. Cardiac output was determined by thermodilution, and oxygen delivery (DO2) was calculated. RESULTS: Early indications of shock were decreases in PtCO2 and intestinal pHi (p less than .01). All measured variables decreased at the second step of bleeding. PtCO2 and subcutaneous PO2 was correlated to DO2 through the entire experiment (r2 = .25 and .49, respectively). Also, the pHi of the small intestine and the sigmoid colon correlated with DO2 (r2 = .36 and .25, respectively). PtCO2 and subcutaneous PO2 correlated with pHi in the small intestine and sigmoid colon. CONCLUSIONS: PtCO2 and pHi in the small intestine and sigmoid colon were the variables that most rapidly indicated blood volume loss. Subcutaneous PO2 and PtCO2, and small intestine and sigmoid colon pHi were correlated to total body oxygen transport. Peripheral tissue perfusion followed intestinal perfusion to some extent.     

Sonoenteroclysis: a new technique for the diagnosis of small bowel diseases

Background Radiologic evaluation of small bowel is usually done by barium examination, which involves considerable radiation exposure. A new sonographic method, sonoenteroclysis, is a promising technique for diagnosing small intestinal disorders. In this study the applicability, performance, and diagnostic yield of sonoenteroclysis were assessed and the results of this novel method were compared with those of barium enteroclysis. Methods Forty-five consecutive patients with suspected small bowel disorder were studied. All patients underwent abdominal ultrasound before and after infusion of an isotonic nonabsorbable electrolyte solution containing polyethylene glycol through a nasojejunal tube (modified Billbao Dotter tube), and images at various levels were obtained. Small bowel wall thickness, luminal narrowing, intestinal dilatation, peristalsis, and extraintestinal complications were noted. It was followed by barium enteroclysis and findings were recorded. Findings of sonoenteroclysis were compared with those of barium enteroclysis. Results Satisfactory distention of the intestinal lumen was obtained with sequential visualization of jejunoileal loops in 34.4 ± 18.4 min. Of 45 patients, 10 showed normal small bowel on sonoenteroclysis and barium enteroclysis. These 10 patients served as controls. Sonoenteroclysis displayed normal diameters smaller than 3.0 and 2.0 cm for the jejunum and ileum, respectively. Bowel wall thickness was 1.7 to 3.0 mm and all five layers of bowel wall could be well appreciated. Valvulae conniventes were clearly visualized with a fold thickness between 1.4 and 2.0 mm. The remaining 35 patients showed abnormalities in the form of strictures, matted bowel loops, dilated loops, thickened folds, deformed ileocecal junction, mass lesions, etc., on sonoenteroclysis and barium enteroclysis. In addition, sonoenteroclysis showed thickened bowel wall with loss of stratification. Extraintestinal findings such as enlarged lymph nodes and ascites were also disclosed at the time of sonography. These were diagnosed subsequently as cases of tuberculosis (n = 23), celiac disease (n = 6), adenocarcinoma (n = 2), leiomyoma (n = 2), Immunoproliferative small intestinal disease (n = 1), and segmental enteritis (n = 1). Conclusions The diagnostic accuracy of sonoenteroclysis for detecting small bowel lesions is comparable to that of barium enteroclysis. This new, widely available, inexpensive, and undemanding technique can be used as an initial investigation in the evaluation of patients with small bowel disorders.     

Normal human intestinal B lymphocytes. Increased activation compared with peripheral blood.

The state of activation of normal human intestinal mononuclear cells obtained from transplant donors was studied. Compared with PBMC, freshly isolated intestinal mononuclear cells expressed significantly more cell surface activation antigens on both B and T lymphocytes. Intestinal mononuclear cells contained significant numbers of immunoglobulin secreting cells immediately after cell separation. This population included CD5-positive B cells that secreted predominantly IgA. Cells from the large bowel consistently revealed higher numbers of IgA secreting cells than cells from the small bowel. Thus, intestinal B cells are markedly activated in vivo compared with PBMC and this increased activation correlates with increased spontaneous antibody secretion. B cells from the large intestine are more highly activated and secrete more antibody than do cells from the small intestine. The intestinal lamina propria lymphoid compartment exhibits a heightened state of activation that may be important for its distinct role in mucosal defense.     

应用鱼油预防大鼠慢性放射性肠炎的研究

目的探讨鱼油对慢性放射性肠炎的预防作用。方法采用随机数字表法将30只雄性SD大鼠分为3组每组10只。实验组放射前7天予鱼油灌胃;对照组放射前7天予生理盐水灌胃;正常组同期予生理盐水灌胃。对照组和实验组大鼠予7 MeV电子线照射腹部10 Gy,正常组不予放射。3组均8周后处死大鼠,获取小肠和血浆标本,行肠壁病理学观察,ELISA法测定血浆白细胞介素（IL）-1、IL-6、肿瘤坏死因子-α（TNF-α）和内毒素含量。结果对照组大鼠肠壁损伤严重,实验组肠壁损伤较轻;实验组大鼠血浆IL-1、IL-6、TNF-α和内毒素含量均明显低于对照组[（348.5±156.1）pg/ml vs（644.9±28.8）pg/ml,（105.5±58.9）pg/ml vs（289.2±63.5）pg/ml,（23.2±9.1）pg/ml vs（90.9±22.3）pg/ml,（13.78±3.68）pg/ml vs（24.62±6.76）pg/ml,均P〈0.01]。结论鱼油对慢性放射性肠炎有预防作用。     

不同体位对妇科肿瘤调强放射治疗剂量学和急性放射性肠炎的影响

目的 探讨妇科肿瘤调强放射治疗（IMRT）采用俯卧位或仰卧位对危及器官剂量学及放射治疗不良反应的影响,优化IMRT体位固定方式。方法 选择42例宫颈癌及子宫内膜癌IMRT患者,按体位固定方式分为俯卧组23例与仰卧组19例。在相同条件下勾画靶区和危及器官并进行治疗计划优化,比较2组患者危及器官剂量-体积关系,分析2组患者急性放射性肠炎的发生情况。 结果 俯卧组小肠接受15~50 Gy照射剂量的体积均小于仰卧组,其中2组接受20、30、40 Gy剂量的体积比较差异均有统计学意义（P均< 0.05）。俯卧组患者结肠接受30、40、45 Gy剂量的体积比较差异均有统计学意义（P均< 0.05）。俯卧组膀胱接受15~50 Gy照射剂量的体积比仰卧组稍升高,但仅接受20 Gy照射剂量的体积在组间比较差异有统计学意义（P < 0.05）。2组患者直肠及股骨头的剂量-体积关系比较差异无统计学意义（P > 0.05）。俯卧组患者消化不良、恶心、呕吐、腹痛和腹泻等急性放射性肠炎的发生率低于仰卧组,但组间比较差异无统计学意义（P均> 0.05）。 结论 妇科肿瘤IMRT采用俯卧位可降低小肠及结肠接受照射剂量。     

Role of polyamines in intestinal adaptation in the rat

The cellular mechanisms controlling adaptive intestinal mucosal hypo- and hyperplasia are poorly understood but changes in tissue polyamine levels and in the activity of the key enzymes controlling their synthesis (ornithine decarboxylase: ODC) and degradation (diamine oxidase: DAO) have been implicated. Therefore, in two models of adaptive mucosal hyperplasia (pancreatico-biliary diversion, PBD, achieved by surgically transposing the jejunum to lie between pylorus and ampulla of Vater, and 90% small bowel resection, SBR-both studied 8 weeks after surgery) and in one model of hypoplasia (8 days total parenteral nutrition) we measured indices of mucosal mass (wet weight, protein and DNA per 10-cm intestine), the growth-associated polyamines (putrescine, spermidine and spermine per 10-cm intestine and per mg DNA) and DAO activity in the duodenum, five 10-cm segments of jejunum, five 10-cm segments of ileum and in the colon, and compared the results with those found in transected or unoperated controls. The results for the indices of mucosal mass confirmed that TPN led to a modest degree of small bowel mucosal hypoplasia whilst PBD, and particularly 90% SBR, stimulated marked adaptive hyperplasia. There were corresponding changes in the amounts of putrescine and spermidine (but not of spermine)-not only when the results were expressed per unit length but also when calculated per mg mucosal DNA and in the ratio of spermidine:spermine. There was an increasing proximal-to-distal gradient in mucosal DAO per unit length intestine in all experimental groups but when the results were expressed per mg DNA, the ileal DAO levels were significantly reduced in the PBD and resection groups, when compared with the controls. These data support the hypothesis that polyamines play a major, and perhaps a controlling, role in regulating adaptive intestinal mucosal growth.     

Congenital intestinal malrotation with gastric wall defects causing extensive gut necrosis and short gut syndrome: A case report

BACKGROUNDCongenital intestinal malrotation (CIM) is a common malformation in neonates. Early diagnosis and surgical intervention can improve the prognosis. CIM combined with congenital gastric wall defect is a potentially fatal condition. We present a severe case of CIM with gastric wall defect causing extensive gut necrosis and short gut syndrome. After three operations, the neonate survived and subsequently showed normal growth and development during infancy.CASE SUMMARYA male neonate (age: 4 d) was hospitalized due to bloody stools and vomiting for 2 d, and abdominal distention for 1 d. Emergent exploratory laparotomy revealed black purplish discoloration of the bowel loops. Bowel alignment was abnormal with congestion and dilatation of the entire intestine, and clockwise mesentery volvulus (720°). The posterior wall of the gastric body near the greater curvature showed a defect in the muscularis layer (approximately 5.5 cm), and a circular perforation (approximately 3 cm diameter) at the center of this defect. Ladd’s procedure was performed and gastric wall defect was repaired. Third operation performed 53 d after birth revealed extensive adherence of small intestine and peritoneum, and adhesion angulated between many small intestinal loops. We performed intestinal adhesiolysis, resection of necrotic intestine, and small bowel anastomosis. CONCLUSIONThis case highlights that prolonged medical treatment may help improve intestinal salvage after surgical removal of necrotic intestines, and improve patient prognosis.