主动吸引引流技术在肠瘘治疗中的特殊应用与价值  

Special Application and Appraisement of Active Suction Drainage in Management of Intestinal Fistula

作　　者：朱黎庆[1] 王钦尧[1] 张敏[1] 朱士驹[1] 黄荣[1] 

机构地区：[1]上海中医药大学附属普陀医院普外科,上海200062

出　　处：《苏州大学学报（医学版）》2005年第4期657-659,共3页Suzhou University Journal of Medical Science

摘　　要：目的研究与评价主动吸引引流技术(ASD)在肠瘘(IF)治疗中的特殊应用与价值。方法回顾分析20例IF4种治疗模式(MTIF-Ⅰ、Ⅱ、Ⅲ、Ⅳ)中,各种形式ASD的应用效果。结果由微型持续吸引系统(MSSD)提供的ASD包括开放式持续吸引(OSSD)、封闭式持续吸引(CSSD)及灌洗式持续吸引(ISSD)。IF局部行OSSD数周后形成管状瘘(TTF),经非手术方法治愈(MTIF-Ⅰ)4例,非手术治疗无效行确定性手术治愈(MTIF-Ⅱ)6例,均无并发引流所致的腹腔残存感染;经行急诊IF确定性手术(MTIF-Ⅲ)4例中的肠道重建部的肠腔内、外分别行CSSD及SSD,各例均未再发生IF;远侧结肠瘘6例在瘘局部行多周ISSD及失功性横结肠造瘘(MTIF-Ⅳ),各例均未并发与ISSD相关的并发症。结论ASD的OSSD、CSSD及ISSD等应用于治疗IF,对治愈患者起到重要作用。在MSSD的控制系统中介入压力传感器,使各种形式的ASD均能进行有效、安全的吸引引流。Objective To study and evaluate the technique of active suction drainage （ASD） in the treatment of intestinal fistula（IF）, Methods The data of multiple forms of ASD in four modes of treated intestinal fistula（MTIF-Ⅰ ,Ⅱ, Ⅲ,Ⅳ）are analyzed retrospectively, Results ASD was afforded by a micro-system of sustained suction drainage （MSSD）, including the forms of open sustained suction drainage （OSSD）, closed sustained suction drainage （CSSD） and irrigating sustained suction drainage （ISSD）, OSSD was applied near IF for several weeks to constructing the tubular type fistula （TTF）, Four cases with TTF were cured by nonoperative methods （MTIF-Ⅰ）. Six cases were cured by elective definitive surgery （MTIF-Ⅱ ） after ineffective conservative treatment. No complications such as intra-abdominal residual infection occurred in the foregoing 10 cases, Four cases underwent emergendy definitive surgery of IF （MTIF-Ⅲ ）. In each of the 4 cases, CSSD and ISSD were combinedly used inside and outside the lumen of reconstructing intestinal tract respectively. No IF recurred postoperatively in all 4 cases. Six cases with distal colonic fistula were treated by defuctional colostomy and peri-fistula ISSD （MTIF-Ⅳ）. All these 6 cases were cured in several weeks. No complication related to using ISSD occurred in these 6 cases. Conclusion The CSSD, OSSD and ISSD of ASD are of great importance in curing IF. The control circuit of MSSD containing a pressure transducer is critical to safer and more effective suction drainage.

关 键 词：肠瘘 主动吸引引流技术 微型持续吸引系统 

分 类 号：R656.705[医药卫生—外科学] R656.905[医药卫生—临床医学]