腹部术后肠外瘘22例诊治体会  

Diagnosis and treatment of intestinal fistula after abdominal operation in 22 cases

作　　者：郭广香[1] 佟景许[1] 韦超 GUO Guang-xiang;TONG Jing-xu;WEI Chao(General Surgery Department, the First Hospital of Fangshan District in Beijing, Beijing 102400, China)

机构地区：[1]北京市房山区第一医院普外科,北京102400

出　　处：《临床医学研究与实践》2018年第12期69-70,共2页Clinical Research and Practice

摘　　要：目的探讨腹部手术后肠外瘘的原因、诊断及治疗方法。方法选择我院22例腹部术后肠外瘘患者,根据其病情采取不同的治疗方法,分析治疗效果。结果 22例肠瘘患者中12例为小肠瘘,7例早期确定性手术,其中初期2例行瘘修补术,1例再瘘死亡,1例微小瘘后保守治愈;后期5例行肠切除、肠吻合均痊愈;另5例保守治疗,经通畅引流、营养支持、禁饮食和持续胃肠减压,2例痊愈,2例后期确定性手术治愈,1例家属放弃治疗。结直肠瘘10例,早期控制性手术3例,其中2例行肠造口粪便转流术获愈,1例行修补再发微小瘘保守治愈;另7例保守治疗全部成功。结论对腹部术后肠瘘应提高认识,及时尽早明确诊断,有效充分地引流、抗感染、合理的营养支持对其至关重要。在此基础上,部分小肠瘘选择早期确定性手术,可提高治愈率,缩短病程。Objective To investigate the causes, diagnosis and treatment of intestinal fistula after abdominal operation.Methods Twenty-two patients with intestinal fistula after abdominal operation in our hospital were selected, different treatment methods were adopted according to their condition, and the treatment effects were analyzed. Results Of 22 cases of intestinal fistula, 12 cases were small bowel fistula, in which 7 cases were performed early definitive operation, including2 cases in prime with fistula, 1 case of refistula and death, 1 case of minor fistula conservatively cured; 5 case in later period after intestinal partial resection and intestinal anastomosis were cured another; 5 cases with conservative treatment（smooth drainage, nutritional support, diet and continuous gastrointestinal decompression）, then 2 cases were cured, 2 cases were cured after definitive surgery, 1 case gave up treatment by family members. Ten cases were diagnosed as colorectal fistula, early control surgery in 3 cases, 2 cases cured by diversion enterostomy, 1 case underwent repair and then micro small fistula and cured lastly; another 7 cases of conservative treatment were successful. Conclusion It should improve the understanding for intestinal fistula after abdominal operation, timely early diagnosis, effective and adequate drainage, antiinfection, and reasonable nutritional support are essential. On the basis of this, early definitive operation is selected for part of the small intestine fistula can improve the cure rate, shorten the course of disease.

关 键 词：腹部手术 肠外瘘 确定性手术 

分 类 号：R656[医药卫生—外科学]