脱细胞真皮基质组织补片治疗管状肠外瘘18例分析  

The analysis of clinical outcomes using acellular dermal matrix patch to treat tubulous enterocuta-neous fistula in 18 cases

作　　者：万松林[1] 刘韦成[1] 茹新宇[1] 田翠萍 丁召[1] 郑科炎[1] 吴云华[1] 江从庆[1] 钱群[1] 

机构地区：[1]武汉大学中南医院结直肠肛门外科/湖北省肠病医学临床研究中心/肠病湖北省重点实验室,430071

出　　处：《临床外科杂志》2017年第9期682-684,共3页Journal of Clinical Surgery

摘　　要：目的探讨应用脱细胞真皮基质组织补片治疗管状肠外瘘的有效性和安全性。方法应用脱细胞真皮基质组织补片填塞治疗管状肠外瘘病人18例,术前均采用瘘管造影确定瘘管走向,除小肠瘘外其他病人均用术中结肠镜确定内口位置以及辅助确定瘘管走向。术后随访了解瘘口周围组织的色泽、弹性、质地,有无局部红肿、疼痛、溢液、异物感,有无全身反应以及瘘管闭合情况。结果病人术后随访全身状况良好,其中12例首次手术后瘘管闭合,周围组织无红肿、疼痛、溢液,临床治愈,短期随访(1年)无复发。6例术后瘘口局部红肿、溢液,瘘复发,3例再次手术后瘘管闭合,临床治愈,短期随访(1年)无复发,3例未愈,肿瘤复发和肠结核各1例。所有病人均无不良反应。结论脱细胞真皮基质组织补片治疗管状肠外瘘安全、可靠。Objective To discuss the effecacy and safety of the clinical application of the acellular dermal matrix patch for the treatment of tubulous enterocutaneous fistula. Methods A retrospective analysis of 18 cases of patients with tubulous enterocutaneous fistula who were treated with acellular dermal matrix patch. All patients were used fistula angiography to determine the fistula direction before the operation,and all,in addition to the patients with small intestine fistula,were used the intraoperative colonoscopy to observe the fistula. To observe the interaction,after operation,of the patch with the surrounding tissue,including the color,elasticity,texture of the surrounding tissue; whether there were local pain,discharge,foreign body sensation,systemic reaction,and the closure of the fistula. Results The postoperative general condition of the patients was fine. 12 cases of patients were clinicaly cured,the fistula was closed after the first surgery and the fistula and surrounding tissue were of no swelling,tenderness and discharge;short-term follow-up（1 year） reported no recurrence. 6 cases of patients had a recurrence of fistula; the fistula had short-term postoperative local swelling and discharge. 3 cases of patients were clinicaly cured with a closed fistula after a second surgery. 3 cases of patients were not cured,among which 1 case was not cured because of tumor recurrence and another 1 case was intestinal tuberculosis. All cases had no adverse reactions. Conslusion To treat tubulous enterocutaneous fistula with acellular dermal matrix patch is safe,reliable and worthy of popularization.

关 键 词：脱细胞真皮基质组织补片 管状肠外瘘 临床疗效 

分 类 号：R656[医药卫生—外科学]