急性出血坏死性胰腺炎并发胃肠瘘的外科治疗

Surgical treatment of gastrointestinal fistulas caused by acute hemorrhagic narcotizing pancreatitis

目的探讨急性出血坏死性胰腺炎（ＡＨＮＰ）并发胃肠瘘的手术治疗时机及其对转归的影响。方法对我院１９８３年８月～１９９８年７月收治的ＡＨＮＰ并发胃肠瘘３３例的临床资料进行回顾性分析。结果３３例中，男２１例，女１２例，年龄４４～６９（平均５６４）岁。病程３９ｄ～１３个月，平均３６个月。２７例痊愈，６例死亡。死亡原因主要是胃肠瘘导致难治性腹腔感染，继发败血症及多器官功能衰竭。结论ＡＨＮＰ并发胃肠瘘与继发感染，胃肠血管栓塞所致血运障碍，多次手术损伤和引流放置不当或时间过长有关。治疗的关键是早期诊断，并应根据病情的不同，选择适当的手术时间和手术方式，以提高治愈率。

Objective To evaluate the occasion for operation and influence on the outcome of gastrointestinal fistulas (GIF) caused by acute hemorrhagic necrotizing pancreatitis (AHNP). Methods The clinical data of 33 patients with GIF caused by AHNP admitted to our hospital from August 1983 to July 1998 were analyzed retrospectively. Results There were 21 males and 12 females with average age 56.4 (from 44 to 69 years old). The average hospital stay was 3.6 months (from 39 days to 13 months). Of them, 23 cases recovered and 6 died. The main causes of death were uncontrolled intraperitoneal infection, secondary sepsis and multiple organ failure. Conclusions The occurrence of GIF caused by AHNP has close relation to the secondary infection, insufficient blood supplement to the GI due to the thrombosis of gastrointestinal vessels and multioperation injuries, inadequate drainage or too long time drainage. The key point of treatment is early diagnosis, and according to individual condition, operation time and models should be properly selected to improve the curative rate.