肠瘘外科治疗方法探讨

Exploration of surgical treatment for intestinal fistula

目的探讨腹部手术后肠瘘的发生原因、诊断及有效的治疗方法。方法调查1999年10月～2008年5月间发生的23例肠瘘。对肠瘘患者的一般情况、疾病诊断、手术经过、肠瘘发生的时间、诊断依据、治疗方法和疗效进行了回顾研究。结果高位肠瘘6例,3例早期修补术仅1例成功,3例保守治疗2例治愈。低位肠瘘17例,其中7例行肠造口粪便转流术7例获愈,另10例保守治疗7例成功,3例死亡。结论肠外瘘大多宜保守治疗,早期修补手术不易成功;有弥漫性腹膜炎者,及时行冲洗引流、粪便转流手术可以降低病死率。

Objective To study the cause of disease, chnical development,treatment and therapeutic effect of the intesti- nal fistula after abdominal operation,explore the reasonable treatment. Methods Postoperative intestinal fistulas were found in 23 cases were studied between Oct, 1999 and May, 2008. The clinical features, diagnosis, operation, duration of symptom, diagnostic basis （symptom and examination） ,treatment and therapeutic effect of the cases were studied retrospectively. Results Only 1 of 3 cases treated with early repair of operation and 2 of 3 cases with conservative methods were cured in 6 cases of high intestinal fis- tulas. 7 patients undergoing diversion enterostomy and 7 of 10 patients with conservative treatment were cured in 17 cases of low intestinal fistulas. Conclusion Conservative treatment is suitable in most of intestinal fistulas, early repair is often unsuccessful. Douche, drainage and fecal diversion in time can lower the mortality of those with diffuse peritonitis.