双套管引流配合早期口服饮食治疗非高流量肠外瘘

Treatment of enterocutaneous fistulas by double cannula with an early oral diet in non-high output enterocutaneous fistula

目的总结双套管引流配合早期正常口服饮食在非高流量肠外瘘病人中的治疗作用。方法胃肠手术后非高流量肠外瘘病人82例,其中治疗组39例,采用双套管引流配合早期口服饮食治疗;对照组43例,采用双套管引流配合全程使用肠内营养制剂治疗。比较两组病人治疗后肠瘘是否愈合、愈合时间以及治疗前后的炎症指标、营养指标改善情况。结果治疗组39例病人愈合33例,瘘口自愈率为84.6%,对照组自愈率为86.0%,两组比较差异无统计学意义(P>0.05)。对照组和治疗组愈合时间分别为(14.7±6.7)天和(16.4±7.2)天,差异有统计学意义(P<0.05)。其中治疗组中,低位瘘自愈率和愈合时间分别为93.1%和15.8天,高位瘘分别为60.0%和19.8天,两组比较差异有统计学意义(P<0.05)。治疗后所有病人肿瘤坏死因子、白细胞介素-6、血浆内毒素、C反应蛋白水平均较治疗前显著改善(P<0.05)。治愈后的营养指标(血红蛋白、血清总蛋白、白蛋白、转铁蛋白、前白蛋白和视黄醇结合蛋白)均增高,其中前白蛋白和视黄醇结合蛋白比对照组高(P<0.05)。结论非高流量肠外瘘病人经双套管引流,早期过渡到正常口服饮食安全有效,而且在低位肠瘘治疗中更有优势。它可减轻病人的炎症反应,改善营养状态,使大部分病人的肠外瘘达到临床愈合,避免再次手术。

Objective To investigate the e-cacy of double cannula with an early oral diet as nu-tritional support treatment on non-high output enterocutaneous fistulas.Methods Clinical data from pa-tients with non-high output enterocutaneous fistula,who treated with double cannula with an early oral diet（n = 39）and double cannula with enteral nutrition therapy（n =43）,were retrospectively analyzed.The fistulas status and its closure time were recorded.In order to investigate the effect of oral diet on fistula,the inflammation index and nutritional status indicators before and after therapy were recorded.Results Totally 33 cases of the 39 patients with non-high output fistula were cured after therapy on the average（16.4 ± 7.2）days.The distal non-high output fistula patients had better results（93.1% closed,15.8 days）than that of the proximal fistula patients（60.0%,19.8 days）.Laboratory inflammation index（TNF-alpha,IL-6,plasma endotoxin and C-reactive protein）were improved significantly（P 〈 0.05）after thera-py.The nutrition status of these patients,such as body weight,hemoglobin,serum total protein,albumin,transferrin,and prealbumin increased at the end of fistula compared to that at the beginning of treatment（P 〈 0.05）.Prealbumin and retinol binding protein were significantly higher than that in the control group（P 〈 0.05）.Conclusion With double cannula treatment,early normal eating for enteral nutrition is safe and effective,especially in distal enterocutaneous fistulas.Normal oral diet can achieve the results of fistu-la closure,reduction of the inflammatory reaction,improvement of the nutrition status,avoiding the inflic-tion of the operation and lowering the cost.