切口疝修补术后肠瘘处理  

Management of intestinal fistula after incisional hernia repair

作　　者：朱彤 刘雨辰[1] 朱熠林[1] 王明刚[1] ZHU Tong;LIU Yu-chen;ZHU Yi-lin;WANG Ming-gang(Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院,北京100020

出　　处：《中国实用外科杂志》2025年第3期289-294,共6页Chinese Journal of Practical Surgery

基　　金：首都卫生发展科研专项(首发2024-2-2038)。

摘　　要：肠瘘是切口疝修补术后的灾难性并发症,病人常伴有不同程度的腹壁及腹腔感染。后续继发的脓毒血症、全身炎性反应综合征(SIRS)及感染性休克等情况,严重威胁着病人生命安全。与普通肠瘘的处理不同,切口疝修补术中留置的人工合成补片增加了肠瘘后续处理的难度。肠瘘引发的腹腔感染是病人高死亡率的始动因素,尽早诊断和及时有效的外科干预是降低病人死亡率的关键。切口疝术后肠瘘的处理具有一定的复杂性和挑战性,基于损伤控制性手术(DCS)理念结合肠瘘病理生理特征制定的阶梯性治疗策略为切口疝术后肠瘘治疗提供了重要思路。Intestinal fistula is a catastrophic complication after incisional hernia repair.Patients are often accompanied by abdominal wall and abdominal cavity infections of varying degrees,and subsequent sepsis,systemic inflammatory response syndrome(SIRS)and septic shock seriously threaten the safety of patients.Different from the conventional treatment of intestinal fistula,the artificial mesh retained in incisional hernia repair increases the difficulty of the subsequent management of intestinal fistula.Abdominal infection caused by intestinal fistula is the initial factor of high mortality.Early diagnosis and timely and effective surgical intervention are the key to reducing the mortality of patients.The management of intestinal fistula after incisional hernia is complicated and challenging.The stepped treatment strategy based on the concept of damage control surgery(DCS)combined with the pathophysiological characteristics of intestinal fistula provides an important idea for the treatment of intestinal fistula after incisional hernia.

关 键 词：切口疝 肠瘘 腹腔感染 外科干预 人工合成补片 术后并发症 液体复苏 营养支持 

分 类 号：R6[医药卫生—外科学]