腹腔结核术后肠外瘘的诊治体会  

Experience in Diagnosis and Treatment of Postoperative Intestinal Fistula in Patients with Abdominal Tuberculosis

作　　者：徐慧海[1] 李亚斋 苏宏伟[1] 齐海亮[1] Xu Huihai;Li Yazhai;Su Hongwei(Hebei Chest Hospital,Shijiazhuang,Hebei 050041,China)

机构地区：[1]河北省胸科医院,河北石家庄050041

出　　处：《四川医学》2021年第4期325-328,共4页Sichuan Medical Journal

基　　金：2019年度河北省卫健委青年科技课题(编号:20191031)。

摘　　要：目的探讨腹腔结核术后肠外瘘发生的原因及临床诊治经验。方法回顾性分析我院2008年1月至2020年1月腹腔结核术后发生肠瘘的36例患者的临床资料,统计分析入组患者术前疾病种类、手术方式,以及术后肠外瘘发生的时间、症状、类型、治疗方法,以及疾病转归及术后随访情况。结果本组患者早期瘘13例,晚期瘘23例,发生时间3-11 d,平均(7.95±3.21) d。低流量瘘22例,高流量瘘14例,瘘液量50-630 ml,平均(488±255) ml。行非手术治疗25例,治愈24例,死亡1例,死因为多器官功能障碍综合征;行确定性手术治疗11例,治愈10例,死亡1例,死因为感染性休克。除2例死亡患者外,其余患者随访情况良好,无肠外瘘复发。结论腹腔结核术后肠外瘘发生率高,选择合适的手术适应证及手术时机,并经充分引流、抗结核、抗感染、营养支持等治疗后,腹腔结核术后肠外瘘可以治愈。Objective To investigate the etiology of and therapy for intestinal fistula after abdominal tuberculosis operation.Methods From Jan 2008 to Jan 2020,36 cases of intestinal fistula after abdominal tuberculosis operation in our hospital were retrospectively analyzed.These results were analyzed,including preoperative disease types,surgical methods,postoperative intestinal fistula occurrence time,symptoms,types,treatment,disease outcomes and postoperative follow-up.Results There were 13 cases of early fistula and 23 cases of late fistula.Time of occurrence was 3 - 11 days with an average of( 7. 95±3. 21) days.There were 22 cases of low flow fistula and 14 cases of high flow fistula.Fistula fluid volume was 50 - 630 ml with an average of( 488±255) ml.25 cases were treated with non-surgical treatment,24 cases were cured,and 1 case died of multiple organ dysfunction syndrome.11 cases were treated with definite operation,10 cases were cured,and 1 case died because of septic shock.Except for 2 patients who died,the rest of the patients were followed up well and no recurrence of external fistula.Conclusion Abdominal tuberculosis would have high incidence of postoperative intestinal fistula by choosing appropriate surgical indications,surgical timing.After adequate drainage,anti-tuberculosis,anti-infection and nutrition support treatment,intestinal fistula of postoperative abdominal tuberculosis could be cured.

关 键 词：腹腔结核 肠外瘘 手术 肠外营养 

分 类 号：R524[医药卫生—内科学]