重症急性胰腺炎并发结肠瘘的原因和治疗

The pathogenesis and treatment of colonic fistula complicated by severe acute pancrcatitis

目的探讨重症急性胰腺炎并发结肠瘘的原因及预防和治疗手段。方法对1985年1月至1997年5月间收治的126例重症急性胰腺炎进行回顾性分析,并对可能导致肠瘘发生的危险因素和采用的治疗方法进行总结。结果 126例手术治疗的重症急性胰腺炎发生结肠瘘25例,25例结肠缕均发生于术后28天内;有胰外感染的较无感染的发生率高(P<0.01);晚期(两周后)手术较早期(两周内)手术发生率高(P<0.05);经后上腰引流术和蝶式引流术较胰床引流术发生率高(P<0.01)。重症急性胰腺炎并发感染较无感染的发生率高(P<0.01)结论结肠瘘的发生是胰外炎性浸润致结肠系膜炎性损伤和手术创伤所致,结肠瘘的治疗应充分考虑原发疾病的状况,并根据结肠瘘的位置、局部炎症情况行近侧肠外置或(和)凡士林油纱布保护,及时引流脓肿和清除感染的坏死组织。

Objective To investigate the cause and treatment for the colonic fistula complication by severe acute pan- creatitis (SAP).Method A retrospective analysis was made on 126 SAP cases admitted from Jan.1985 to May 1997 in order to evaluate the risk factors of complicated colonic fistula and surgical management.Result Colonic fistula developed in 25 cases out of 126 SAP cases undergoing surgery,all were within 4 weeks postop. Fistula developed more commonly in those with peripancreatic infection than those without (P<0.01).The likelihood of fistula was larger in those undergoing laparotomy two weeks after the onset of the SAP than those within two weeks (P<0.05).Patients of SAP undergoing posterior or butterfly pattern drainage were more prone to fistula than those receiving drainage of pancreatic bed (P<0.01),and fistula was more common in in- fected SAP than without infection (P<0.01).Thus the risk factors included peripancreatic inflammatory infil- tration in the omental sac and retrocolonic space,open especially retroperitoneal drainage.Conclusion Inflam- matory infiltration,infection and improper surgical procedures often result in colonic fistula and its management should depend upon the patients status,the position of the fistula and intraperitoneal inflammation.