肠外瘘的治疗

Management of enteric fistula

目的 探讨当前肠外瘘治疗的成功点与今后需要改进之处。 方法 回顾性分析在1971年 1月～ 2 0 0 0年 12月期间 1168例肠外瘘的治疗结果。 结果 1168例患者的治愈率为93 0 % ,其中 3 7 1%经非手术治疗后愈合。病死率为 5 5 % ,主要死于感染 ( 60 / 65 )。 65 9例接受手术治疗 ,647例获得成功 ( 98 2 % )。第二阶段 ( 1985年 1月～ 2 0 0 0年 12月 )的治愈率、病死率与手术成功率 ( 94 2 %、4 4 %、99 7% )均较第一阶段 ( 1971年 1月～ 1984年 12月 )的结果 ( 90 4 %、8 2 %、95 5 % )为佳 (P <0 0 5 )。 结论 本组病例取得治疗成功的基点是改变了治疗策略 ,将手术治疗作为最后的措施 ;改进了控制感染的方法 ;重视营养支持与生命器官的监测。为了进一步取得肠外瘘治疗的效果 ,缩短治疗疗程与减少费用 ,今后应研究促进管状瘘自愈的方法 ,改进特殊病因肠瘘的治疗以及早期施行肠瘘的确定性手术。

Objective To evaluate the essentials for successful management of entero cutaneous fistulas and their improvement. Methods We analyzed the therapeutic results of 1 168 cases treated in a single center from January 1971 to December 2000. Results In these patients, the cure rate of fistulas was 93 0% and 37 1% after non operative treatment. Most cases died of sepsis (60/65 cases,93 2%) with a total mortality of 5 5%. In 659 cases who had undergone operation for enteric fistula, 647 (98 2%) recovered. The cure rate, mortality rate and successful rate of operation (94 2%, 4 4%, 99 7%) in the period of January 1985 December 2000 were better than those (90 4%, 8 2%,95.5%) in the early period of January 1971 Decemeber 1984( P< 0 05). Conclusions The change of therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs are essential to the management of enteric fistulas. How to increase the spontaneous closure of fistula, the therapeutic rate of specific enteric fistula (eg IBD, radiation enteritis) and the operative rate of enteric fistula in the early period requires further study.