腹腔开放并发肠空气瘘191例诊疗分析  

Treatment of open abdomen combined with entero-atmospheric fistula:A retrospective study

作　　者：张锦鹏 滕依恬 刘野 田芮瑕 张哲瑞 吴磊 洪之武 任华建 王革非 任建安 Zhang Jinpeng;Teng Yitan;Liu Ye;Tian Ruixia;Zhang Zherui;Wu Lei;Hong Zhiwu;Ren Huajian;Wang Gefei;Ren Jian'an(Research Institute of General Surgery,Jinling Hospital,the Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China;Department of Clinical Medicine,Medical School of Nanjing University,Nanjing 210093,China;Medical School of Southeast University,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)全军普通外科研究所,南京210002 [2]南京大学医学院临床医学系,南京210093 [3]东南大学医学院临床医学系,南京210009

出　　处：《中华胃肠外科杂志》2023年第9期853-858,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省重点研发计划(BE2022823);江苏省医学创新中心(CXZX202217)。

摘　　要：目的探讨腹腔开放患者并发肠空气瘘的临床诊治特点。方法采用观察性研究方法。对南京大学医学院附属金陵医院(东部战区总医院)暨全军普通外科研究所2012年1月至2021年1月期间,收治的腹腔开放并发肠空气瘘患者的临床资料进行回顾性分析。观察指标主要为患者的基本信息、原发病、腹腔开放原因、肠空气瘘的瘘口位置及其瘘口管理策略(三套管近端肠管收集肠液,远端回输;或使用3D打印肠瘘支架进行封堵)、腹腔开放治疗时间、确定性手术(切除瘘段肠管后,采取腹壁组织层次分离技术并根据缺损大小及腹壁顺应性,选择放置生物补片行肠道重建和腹壁修补)等待时间及腹壁缺损处理方法、入住重症监护室(ICU)和总住院时间等。根据腹腔开放创面临时关腹的措施分为创面植皮组和单纯缝合皮肤组,并分析比较两组患者的临床特征和治疗情况。结果共计收治214例腹腔开放并发肠空气瘘的患者,除去23例死亡(11例多器官功能衰竭,5例腹腔出血,4例肺部感染,气道出血、坏死性筋膜炎及外伤致颅脑损伤各1例)外,191例实施确定性手术的患者纳入分析。男性156例(81.7%),年龄(46.5±2.5)岁。原发病中外伤89例(46.6%),胃肠肿瘤31例(16.2%),消化道穿孔22例(11.5%),肠梗阻17例(8.9%),急性胰腺炎和其他32例(16.8%)。腹腔开放原因依次为严重腹腔感染(137例,71.7%)、损伤控制性手术(29例,15.2%)和腹腔高压(25例,13.1%)。瘘口位置:胃15例(7.8%),小肠105例(55.0%),结肠25例(13.1%),多发瘘46例(24.1%)。单纯缝合皮肤组104例,创面植皮组87例。相较创面植皮组,单纯缝合皮肤组男性患者占比更低[74.7%(65/87)比87.5%(91/104),χ^(2)=5.176,P=0.023],年龄更大[(48.3±2.0)岁比(45.0±1.9)岁,t=-11.671,P<0.001],外伤患者占比更少[32.2%(28/87)比58.7%(61/104),χ^(2)=13.337,P<0.001];重症监护住院时间更短[(8.9±1.0)d比(12.7±1.6)d,t=19.281,P<0.001],总住院时�Objective The purpose of this study was to analyze the course and outcome of patients with combined entero-atmospheric fistulas in open abdomen treatment.Methods In this retrospective observational study,we collected data on 214 patients with open abdomen complicated by entero-atmospheric fistulas admitted to Research Institute of General Surgery,Jinling Hospital,Affiliated Hospital of Medical School from January 2012 to January 2021.We collected their basic characteristics,aetiology,treatment plan,and prognosis,including the durations of hospitalization and open treatment,time to resumption of enteral nutrition,duration and prognosis of definitive surgery,and overall prognosis.Results Of the 214 patients with open abdomen complicated with entero-enteral fistulas,23(10.7%)died(11 of multiple organ failure caused by abdominal infection,five of abdominal cavity bleeding,four of pulmonary infection,one of airway bleeding,one of necrotizing fasciitis,and one of traumatic brain injury).The remaining 191 underwent definitive surgery at our hospital.The patients who underwent definitive surgery were predominantly male(156 patients,81.7%);their age was(46.5±2.5)years.Trauma and gastrointestinal tumors(120 cases,62.8%)predominated among the primary causes.The reasons for abdominal opening were,in order,severe abdominal infection(137 cases,71.7%),damage control surgery(29 cases,15.2%),and abdominal hypertension(25 cases,13.1%).Temporary abdominal closure measures were used to classify the participants into a skin-only suture group(104 cases)and a skin-implant group(87 cases).Compared with the skin-implant group,in the skin-suture-only group the proportion of male patients was lower(74.7%[65/87]vs.87.5%[91/104],χ^(2)=5.176,P=0.023),the mean age was older([48.3±2.0]years vs.[45.0±1.9]years,t=-11.671,P<0.001),there were fewer patients with trauma(32.2%[28/87]vs.58.7%[61/104],χ^(2)=13.337,P<0.001),intensive care stays were shorter([8.9±1.0]days vs.[12.7±1.6]days,t=19.281,P<0.001),total length of stay was shorter([29.3±

关 键 词：腹腔开放 肠空气瘘 腹腔感染 肠内营养 

分 类 号：R656[医药卫生—外科学]