DSA导引下经窦道α-氰基丙烯酸正丁酯改良胶封堵术治疗胃肠术后肠外瘘15例

DSA- guided trans- sinus injection of Glubran 2 for the closure of intestinal fistula caused by gastrointestinal operation: initial experience in 15 cases

目的 评价DSA导引下经窦道α-氰基丙烯酸正丁酯改良胶（Glubran 2）封堵术在治疗胃肠术后肠外瘘中的疗效。方法 回顾2012年9月至2014年9月胃肠手术后肠外瘘患者15例,分析应用DSA导引下经窦道Glubran 2封堵术治疗肠外瘘的愈合情况。结果 15例胃肠术后肠外瘘患者中,14例一次封堵成功,1例3个月后复发,再次封堵后治愈;13例胃肠术后出现吻合口瘘或肠瘘,经过3～4周保守治疗及通畅引流后,经窦道造影确诊为肠外瘘,予以Glubran 2封堵成功,2例造影后放置引流管,2～5 d后封堵成功,1周内治愈出院。结论 DSA导引下经窦道Glubran 2封堵术治疗胃肠术后肠外瘘可以有效促进肠外瘘的愈合,可在肠外瘘形成早期使用,疗效可靠,对高龄患者更有优势。

[Abstract] Objective To evaluate the therapeutic effect of DSA-guided trans-sinus injection of N- Butyl- （2）-Cyanoaerylate＋Methacryloxysulfolane glue （Glubran 2） in obstructing intestinal fistula caused by gastrointestinal operation. Methods A total of 15 patients with intestinal fistula after gastrointestinal operation, who were admitted to authors＇ hospital during the period from Sep. 2012 to Sep. 2014, were included in this study. DSA-guided trans-sinus injection of Glubran 2 to obstruct the intestinal fistula was carried out in all 15 patients. The clinical results were retrospectively analyzed. Results Of the 15 patients with postoperative external intestinal fistula, the closure of the fistula with injection of Glubran 2 was successfully accomplished with single procedure in 14, and recurrence of intestinal fistula at three months after the treatment was seen in one, which was cured after second procedure. Thirteen cases developed anastomotic fistula or intestinal fistula after gastrointestinal operation, which was treated with conservative treatment for about 3-4 weeks till the drainage became unobstructed and the subsequent sinus radiography confirmed the diagnosis of external intestinal fistula, and the obstruction of fistula with Glubran 2 was successfully carried out. In 2 cases the drainage tube was placed after sinus radiography, and 2-5 days later obstruction of fistula with Glubran 2 was successfully performed, and within one week the patients were cured and discharged. Conclusion DSA-guided trans-sinus injection of Glubran 2 closure technique can effectively promote the healing of external intestinal fistula caused by gastrointestinal surgery. This treatment can be employed in the early stage of intestinal fistula formation and is more suitable for elderly patients, and its curative effect is reliable