重症急性胰腺炎继发肠瘘的外科治疗策略  

Surgical management strategies for secondary intestinal fistula in severe acute pancreatitis

作　　者：黄骞 孙冉 HUANG Qian;SUN Ran(Department of General Surgery,Affiliated Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院普通外科研究所,江苏南京210002

出　　处：《中国实用外科杂志》2025年第3期284-289,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82070579)。

摘　　要：肠瘘通过引起腹腔感染、加剧内稳态失衡及增加营养风险等途径增加了重症急性胰腺炎(SAP)的病死率,是SAP晚期较为棘手的并发症。肠瘘的发生机制与胰周组织压迫侵蚀、肠道血运障碍和医源性操作密切相关。早期诊断的关键在于提高对肠瘘的警惕性,灵活运用CT、消化道及窦道造影和胃肠镜等技术明确瘘口位置。SAP继发肠瘘的外科治疗策略遵循分阶段治疗原则:非手术治疗阶段强调以感染源控制为核心,联合肠内营养、器官功能支持等积极促进肠瘘自愈;确定性手术阶段的策略则取决于瘘口位置,对胃、十二指肠等高位瘘优先保守治疗,而结肠瘘则需更积极的手术干预。Intestinal fistula,a formidable complication in the late stage of severe acute pancreatitis(SAP),significantly elevates mortality through mechanisms including intraabdominal infection induction,exacerbation of homeostatic imbalances,and increased nutritional risk.Its pathogenesis is multifactorial,involving mechanical compression/enzymatic erosion by peripancreatic necrotic tissues,intestinal ischemia and iatrogenic injury from invasive interventions.Early diagnosis requires a heightened clinical awareness and the judicious use of diagnostic modalities,including computed tomography(CT),fistulography,and endoscopy,to delineate the anatomical location of the fistula.Surgical management adheres to a staged therapeutic paradigm:during the conservative treatment phase,infection source control remains the cornerstone,supplemented by enteral nutrition,organ function support,and other adjunctive measures to promote spontaneous fistula closure;in the definitive surgical phase,the therapeutic approach is dictated by the anatomical location of the fistula,with conservative management prioritized for upper gastrointestinal fistulas,such as those involving the stomach and duodenum,and more aggressive surgical intervention for colonic fistulas.

关 键 词：重症急性胰腺炎 肠瘘 腹腔感染 外科治疗 

分 类 号：R657.5[医药卫生—外科学]