全肠外营养加生长抑素或其类似物在肠外瘘中的应用

Treatment of gastrointestinal fistulas with a combination of TPN and somastostatin or somastostatin analogue

目的：观察ＴＰＮ＋生长抑素或生长抑素类似物治疗肠外瘘的效果。方法：１９９０～１９９８年期间收治不同类型的管状瘘６０例，在有效的腹腔双套管引流和ＴＰＮ治疗同时，应用生长抑素（１４肽）或生长抑素类似物（８肽）。观察肠液量、肠瘘愈合时间、肝、肾功能和动脉血气分析的改变。结果：４６例自愈，１３例手术治愈，１例死于脑溢血。总治愈率为９８．３％，非手术自愈率７６．７％，平均自愈时间为（１７．１±１２．４）天。其中空肠瘘自愈时间最短，为（１１．３±６．７）天。有７例经治疗后瘘口缩小，并形成完整的窦道，经水压法或医用ＯＢ胶堵塞后自愈。结论：在控制腹腔感染和有效腹腔双套管冲洗引流情况下，应用ＴＰＮ＋生长抑素或生长抑素类似物可以明显提高肠外瘘的自愈率。

Objectives:Post surgical gastrointestinal fistula is a frequent problem aroud world.We present our experience with a combination of TPN and somatostatin or somatostatin analogue(octreotide) used in 60 patients with gastrointestinal fistulas between 1990￣1998. Methods:All patients were treated with TPN support,antibiotics and drawing.We used somatostatin or somatostatin analogue(octreotide) after abdorminal infection was controlled. Results:In 60 patients,spontaneous closure of the fistula was achieved in 76.7% after a mean of (17±12.4) days of drug treatment.Thirteen patients required reoperation and one patient died of brain disease. Conclusions:The method of TPN+somatostatin or its analogue is a useful therapeutic complement in the management of post surgical gastrointestinal fistulas,because it accelerates their spontaneous closure.