早期干预性手术和肠内外营养治疗肠外瘘的疗效评价(24例报告)

The clinical evaluation of early interventional surgery and parenteral,enteral nutrition for the treatment of external intestinal fistulas

目的评估早期应用"干预性手术"和肠内外营养治疗复杂性肠外瘘的临床意义及疗效。方法依据早期"干预性手术和肠内外营养"与全程完全保守措施的不同治疗方法,对24例肠外瘘病例资料分组研究,比较两组患者治疗后临床指标的差别。结果干预性手术和肠内外营养组瘘口治愈率明显高于完全保守治疗组(87.50%vs37.50%);第4周肝功能损害率、瘘口平均愈合时间、平均住院时间、平均住院费用与后者比较均有显著下降(P<0.01);两组间肺部感染、败血症、切口疝、粘连性肠梗阻等近、远期并发症发生率和死亡率、再入院率差异无统计学意义(P>0.05)。结论复杂性肠外瘘早期实施积极的"干预性手术"和肠内外营养治疗是肠外瘘外科治疗观念的重要转变,有利于提高肠外瘘的治愈率。

Objective To evaluate the clinical value and curative effects on the use of early interventional complicated external intestinal fistulas. Methods The clinical index difference of two group data （24 cases）between the early interventional surgery and nutritional therapy and complete conservative treatment were contrasted. Results In the cure rate of fistalous orifice,interventinal surgery and parenteral,enteral nutrition group was higher than that complete conservative treatment group. （87.50% vs 37.50%）. The liver functional damage rate at the fourth week and average fitulous healing time or hospitalization and the cost of hospitalization were less significantly than the latter （P〈 0.01）. The difference of complication rate （recent or long-time）such as pulmonary infection, septicaemia,incisional hernia,adhensive small-bowel obstruction and death rate or readmission rate between the two groups were no significant difference（P〉0.05）. Conclusions An active measures of early interventional surgery and parenteral, enteral nutrition are contribute to improve the cure rate of external intestinal fistulas.