胃肠道术后显性肠瘘与隐性肠瘘临床特征分析

Clinical features of dominant intestinal fistula and recessive intestinal fistula after gastrointestinal surgery

目的 通过回顾性分析胃肠道手术后显性肠瘘与隐性肠瘘的相关临床特征,探讨隐性肠瘘的临床特点与诊治方法.方法 回顾性分析80例肠瘘病人的临床资料,根据其腹腔引流物的性状分为显性肠瘘组（n=50）、隐性肠瘘组（n=30）,对比性分析其性别、年龄、原发病的手术部位、病人的合并疾病、病人的肠瘘相关临床症状、肠瘘后相关实验室检验结果、治疗方式、病情转归、住院天数等临床资料,探讨、分析隐性肠瘘独特的临床特征,及其在临床诊治中的意义.结果 隐性肠瘘组与显性肠瘘组在性别、年龄和原发病的手术部位、合并疾病以及肠瘘相关临床症状等方面差异均无统计学意义（P＞0.05）;两组的血淀粉酶、血胆红素、中性粒细胞百分比、中心静脉压、尿比重、红细胞压积差异也均无统计学意义（P＞0.05）;而显性肠瘘与隐性肠瘘两组病人影像学检查及引流物中淀粉酶[（3 988.0±1 912.0） U/L与（105.2±49.3） U/L]、胆红素[（220.4±122.0）μmol/L与（69.1±40.3）μmol/L]含量差异均有统计学意义（P＜0.05）.显性肠瘘组病人均接受了手术治疗,其中3例出现血管内弥漫性凝血（DIC）、2例出现多器官衰竭而死亡,其余病人均痊愈;隐性肠瘘组病人初期均保守治疗,其中4例在治疗过程中转化为显性肠瘘,二期行手术治疗,2例后期分别出现DIC、多器官衰竭而死亡,其余病人均痊愈.隐性肠瘘病人的住院时间[（13±8）d]明显短于显性肠瘘病人[（27±10）d],差异有统计学意义（P＜0.05）.结论 隐性肠瘘作为一个独立的临床分型与显性肠瘘既有区别,又有联系,其可转化为显性肠瘘,具有独特的临床特性与转归,在临床上需特别重视.

Objective To retrospectively analyze the clinical characteristics of dominant intesti- nal fistula and recessive intestinal fistula after gastrointestinal surgery. Methods We retrospectively analyzed the clinical data of 80 patients with intestinal fistula, including dominant intestinal fistula group （n = 50） and the recessive intestinal fistula group （n = 30） according to their material properties of abdominal cavity drainage. The gender, age, surgical site of primary disease, the merger diseases, clinical symptoms of intestinal fistula, the relevant laboratory testing results after intestinal fistula, treatment, disease outcomes and hospitalization days were compared between two groups. The unique clinical features of recessive intestinal fistula and the significance in the clinical diagnosis and treatment were explored. Results There were no statistically significant differences （P〉0. 05） between reces- sive intestinal fistula group and dominant intestinal fistula group in terms of gender, age, surgical site of primary disease, merger diseases, and clinicat symptoms of intestinal fistula. NEUT%, blood bili- rubin, white blood cells, central venous pressure, urine specific gravity and hematocrit also had no statistically significant differences （P〉0. 05） between the two groups, but results of imaging exami- nations and the readings of amylase and bilirubin in drainage showed statistically significant differences （P〈0. 05）. In the dominant intestinal fistula group, all patients received surgical treatment, except the deaths of 3 patients with DIC and 2 with multiple organ failure, the patients were recovered. In re- cessive intestinal fistula group, the patients all received conservative treatment at first, among them 4 cases converted to dominant intestinal fistula in the treatment process, which received phase Ⅱ surgi- cal treatment, 2 cases suffered from DIC or multiple organ failure and died, and the rest of the patients were recovered. The hospitalized time in patients with recessive intestinal fistula was significantly shorter than that in those with dominant intestinal fistula （P〈0. 05）. Conclusions There are differ- ences and contacts between recessive intestinal fistula as an independent clinical classification and domi- nant intestinal fistula. The recessive intestinal fistula can be converted into dominant intestinal fistula, with unique clinical features and outcome, and special attention should be paid to it in clinic.