肠外瘘临床综合诊治的探讨  

Study on clinical diagnosis and treatment of entreocutaneous fistula

作　　者：汪龙[1] 王晓通[1] 麦威[1] 李雷[1] 毕连臣[1] 牙韩清[1] 钟晓刚[1] 徐胜[1] 朱州[1] 张贵年[1] 韦斌[1] 谢思[1] 余俊英[1] 黄顺荣[1] WANG Long;WANG Xiao-tong;MAI Wei;Li Lei;Bi Lian-cheng;Ya Han-qing;Zhong Xiao-gang;Xu Sheng;Zhu Zhou;Zhang Gui-nian;Wei Bing;Xie Si;Yu Jun-ying;Huang Shun-rong(Department of Gastrointestinal Surgery,the People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院胃肠外科,南宁530021

出　　处：《中国临床新医学》2018年第3期217-220,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：国家自然科学基金资助项目(编号:81360369);广西卫计委科研课题(编号:Z2015362)

摘　　要：目的探讨肠外瘘的综合诊断与治疗的方法与效果。方法回顾性分析该院2013-06~2017-01收治的149例肠外瘘(由外院转入119例)的临床治疗结果。结果 149例肠外瘘患者经治疗后顺利出院129例(86.58%),放弃治疗自动出院13例(8.72%),死亡7例(4.70%),主要死于严重感染及多器官功能衰竭。其中腹部外伤致肠外瘘18例(12.08%),其余多为腹部外科手术后1~2周出现肠外瘘,经通畅引流、抗感染、营养支持等治疗后大部分肠外瘘患者好转或治愈。而其中8例结直肠外瘘早期行回肠造瘘术或结肠造瘘术,12例肠外瘘患者行二期闭瘘术或二期肠瘘切除术+消化道重建术。结论该组肠外瘘患者取得治疗成功的关键是早期通畅有效的腹腔冲洗引流,同时强力有效的抗感染、营养支持与生命器官的监测是成功的基础。Objective To study the clinical diagnosis and treatment of entreocutaneous fistula.Methods The clinical data of 149 cases with enterocutaneous fistula,of whom 119 cases were transfered to our hospital from other hospitals during June 2013 and January 2017 were retrospectively analyzed.Results After comprehensive treatments,129 cases(86.58%)were successfully cured while 13 cases(8.72%)gave up the treatment and were discharged on request,7 cases died mainly because of severe sepsis and multiple organ failure.In these patients,abdominal trauma caused intestinal fistula in 18 cases(12.08%),and the other patients suffered from intestinal fistula 1 to 2 weeks after abdominal surgery.All the patients were diagnosed with intestinal fistula through auxiliary imaging examination or abdominal puncture and bacterial culture.Most the patients were cured or improved by the treatments of complete drainage,anti-infection and nutrition support.8 cases were performed ileum colostomy surgery in the early stage and 12 cases were performed two-stage operation of fistula closed surgery or Intestinal fistula resection+Intestinal fistula resection.Conclusion Complete drainage in early stage is the key factor for successful treatment and effective anti-infection,nutritional support and vital signs and major organs monitoring are the foundation of a good clinical outcome for the patients with entreocutaneous fistula.

关 键 词：肠外瘘 腹腔引流 营养支持 抗感染 

分 类 号：R619[医药卫生—外科学]