肠内营养联合“升阶梯”引流治疗急性坏死性胰腺炎并发十二指肠瘘的疗效分析  

Analysis of the efficacy of enteral nutrition combined with step-up drainage in the treatment of acute necrotizing pancreatitis complicated by duodenal fistula

作　　者：张敬柱 李刚[1] 周晶[1] 叶博 柯路 童智慧 李维勤 ZHANG Jingzhu;LI Gang;ZHOU Jing;YE Bo;KE Lu;TONG Zhihui;LI Weiqin(Severe Acute Pancreatitis Treatment Center of the Department of Critical Care Medicine,Jinling Clinical Medical College,Nanjing University of Chinese Medicine/General Hospital of Eastern Theater Command,Nanjing 210002,China)

机构地区：[1]南京中医药大学金陵临床医学院/中国人民解放军东部战区总医院重症医学科重症胰腺炎治疗中心,江苏南京210002

出　　处：《中国普通外科杂志》2024年第9期1473-1480,共8页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(82270678)。

摘　　要：背景与目的:急性坏死性胰腺炎治疗后期出现感染性胰腺坏死(IPN)并发十二指肠瘘,容易出现肠内营养实施困难、水电解质紊乱、腹腔出血、感染加重等严重并发症,是目前临床上的治疗难题。本研究探讨肠内营养联合“升阶梯”引流治疗IPN并发十二指肠瘘的疗效,并分享单中心经验。方法:回顾性分析2018年1月—2020年12月中国人民解放军东部战区总医院重症胰腺炎治疗中心行肠内营养联合“升阶梯”引流治疗的66例IPN并发十二指肠瘘患者的临床资料。结果:66例患者从发病至并发十二指肠瘘的中位时间为53(32~75)d,有46例(69.7%)从引流管或双套管中引流出可疑消化液样液体;49例(74.2%)通过窦道造影明确十二指肠瘘的诊断和位置,其余通过术中探查或内镜确诊;十二指肠瘘主要分布在十二指肠水平部(33.3%)或降部(50.0%)。61例(92.4%)通过鼻肠管置入安全建立肠内营养通路,5例(7.6%)患者需要通过手术方式建立肠内营养通路;20例(30.3%)继发腹腔出血,14例(21.2%)死亡。在52例治愈患者中,49例(94.2%)通过“升阶梯”引流治愈,3例(5.8%)因长期未愈行手术治疗。49例非手术治疗患者中,经引流管引流十二指肠瘘治愈10例(20.4%),经双套管持续冲洗引流十二指肠瘘治愈39例(79.6%)。非手术治疗患十二指肠瘘治愈的中位时间为41(29~80)d。结论:IPN并发十二指肠瘘患者病情危重,肠内营养联合“升阶梯”引流是该类患者的有效治疗手段。Background and Aims:The occurrence of duodenal fistula following infected pancreatic necrosis(IPN)in the later stage of treatment for acute necrotizing pancreatitis presents a significant clinical challenge.It often leads to severe complications such as difficulty in administering enteral nutrition,electrolyte imbalances,abdominal bleeding,and worsening infections.This study was performed to explore the efficacy of enteral nutrition combined with step-up drainage in treating IPN complicated by duodenal fistula and to share single-center experience.Methods:The clinical data of 66 patients with IPN complicated by duodenal fistula who underwent enteral nutrition combined with step-up drainage in the Severe Pancreatitis Treatment Center of the Nanjing Eastern Theater General Hospital between January 2018 and December 2020 were retrospectively analyzed.Results:Among the 66 patients,the median time from disease onset to the development of duodenal fistula was 53(32-75)d.In 46 cases(69.7%),suspicious digestive fluid-like discharge was observed from drainage tube or double-lumen tube.The diagnosis and location of the duodenal fistula were confirmed in 49 patients(74.2%)through fistulography,while the remaining cases were confirmed via surgical exploration or endoscopy.The duodenal fistulas were mainly located in the horizontal part(33.3%)or descending part(50.0%)of the duodenum.Nutritional access was safely established through nasojejunal tube in 61 patients(92.4%),while 5 patients(7.6%)required surgery to establish the access.Twenty patients(30.3%)experienced secondary abdominal bleeding,and 14 patients(21.2%)died.Among the 52 patients who recovered,49(94.2%)healed through step-up drainage,while 3(5.8%)required surgery due to delayed healing.Of the 49 patients who underwent non-surgical treatment,10(20.4%)achieved fistula closure through drainage tube,and 39(79.6%)achieved closure through continuous lavage drainage via double-lumen tube.The median healing time for duodenal fistula in nonsurgically treated patients was 4

关 键 词：胰腺炎 急性坏死性 肠瘘 肠道营养 引流疗法 

分 类 号：R657.5[医药卫生—外科学]