一例腹腔开放合并肠空气瘘患者的全程管理经验  

Whole-course management of abdominal opening with enteroatmospheric fistula

作　　者：仲卫冬 胡根 赵振国 王镇 刘金春 李威 戴丽强 浦凌宵 王苏睿 沈玥帆 薛徐夏 邵国益 Zhong Weidong;Hu Gen;Zhao Zhenguo;Wang Zhen;Liu Jinchun;Li Wei;Dai Liqiang;Pu Lingxiao;Wang Surui;Shen Yuefan;Xue Xuxia;Shao Guoyi(Department of General Surgery,Jiangyin Clinical College of Xuzhou Medical University,Jiangyin 214400,China;Jiangyin Clinical College of Xuzhou Medical University,Jiangyin 214400,China;Jiangyin People's Hospital Affiliated to Nantong University,Jiangyin 214400,China)

机构地区：[1]徐州医科大学江阴临床学院,江阴市人民医院综合普外一科,江阴214400 [2]徐州医科大学江阴临床学院,江阴月214400 [3]南通大学附属江阴医院,江阴214400

出　　处：《中华胃肠外科杂志》2025年第3期323-326,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：江阴市卫生健康委员会青年科研项目(Q202204);江阴市中青年卫生优秀人才项目(JYROYT202301);徐州医科大学附属医院发展基金重点项目(XYFZ202302)。

摘　　要：腹腔重症感染可危及患者生命,是困扰外科医生的难题。本文介绍一例长时间受感染打击、经历多次手术创伤的腹腔重症感染合并吻合口瘘的高龄患者,患者人住我科后手术探查发现肠管广泛水肿且粘连、吻合口瘘、腹腔污染伴感染,根据损伤控制外科理念,采取吻合口瘘旷置、腹腔开放、腹腔双套管持续冲洗吸引等措施有效控制感染,负压创面治疗技术管理腹腔开放创面、负压辅助引流装置管理肠空气瘘,腹部创面肉芽组织化后进行植皮,诱导肠空气瘘转为肠皮肤瘘,3D打印造口底盘管理消化道瘘,同时加强肠外和肠内营养支持。6个月后顺利完成确定性肠瘘切除和腹壁缺损修复。Severe intra-abdominal infections are life-threatening conditions and a significant challenge for surgeons.This article presents a case of an elderly patient with a severe intra-abdominal infection complicated by an anastomotic leak.This patient had experienced prolonged sepsis and multiple surgical traumas.Upon admission to our department,exploratory surgery revealed extensive bowel edema and adhesions,an anastomotic leak,and abdominal contamination with infection.In accordance with the principles of damage control surgery,the anastomotic leak was exteriorized,the abdomen was left open,and continuous intra-abdominal lavage with dual-lumen catheters was implemented to effectively control the infection.Negative pressure wound therapy was used to manage the open abdomen,and a negative pressure-assisted drainage device was used to manage the enteroatmospheric fistula.After granulation of the abdominal wound,split-thickness skin grafting was performed.The enteroatmospheric fistula was converted into an enterocutaneous fistula.A 3D-printed stoma baseplate was used to manage the digestive fistula.Concurrently,enhanced parenteral and enteral nutritional support was provided.Six months later,the patient successfully underwent definitive fistula resection and abdominal wall defectrepair.

关 键 词：腹腔感染 肠空气瘘 口吻合口瘘 腹腔开放 负压创面治疗 损伤控制外科 

分 类 号：R656[医药卫生—外科学]