肠外瘘:20年的经验

Enterocutaneous fistula:twenty years experience

1971年～1991年间治疗624例肠外瘘,481例(77%)为手术引起,其它致瘘原因为外伤、炎性肠道疾病、放射性损伤与肿瘤。经治疗后,196例(31.4%)的瘘口自愈,363例(58%)手术治愈,手术成功率为98.4%,全组死亡率为8.7%。作者认为当前改善肠外瘘治疗效果的关键是控制感染,强调在早期进行有效的引流,重视对器官功能的监测与维护。肠外与肠内营养支持在肠外瘘治疗中可互补其不足。肠部分切除吻合与肠浆肌层片修补术是主要的手术方式。

Six hundred twenty four patients of enterocutaneous fistula were evaluated in this study that spanned the years 1971 to 1991.In the majority of patients (481 cases,77%),the fistula was resulted from the operation.Others were secondary to trauma,inflammatory bowel diseases,irridiation or tumor.The fistula was closed spontaneously after nonoperative treatment in 196 cases (31.4%) and other 363 cases were cured by surgery.54 patients died with a mortality rate of 8.7%.The chief cause of failure was sepsis and multiple organ failure.The authors emphasize the sisnificance of early control of infection,suitable nutritional support and careful monitoring of vital organs for improving the outcome of enteric fistula patient.They also recommend the bowel resection or pedicled intestinal seromuscular patch as the operative procedure for the enteric fistula.