损害控制在肠外瘘致严重腹腔感染再次手术中的应用

The application of damage control surgery in the reoperation of complicated intra-abdominal infection after enterocutaneous fistulas

目的探讨损害控制在肠外瘘致严重腹腔感染再次手术中的应用。方法回顾性研究2013年6月—2017年1月广西壮族自治区人民医院胃肠外周血管外科收治的因腹腔感染严重需再次手术治疗的肠外瘘患者24例的临床资料,男性19例,女性5例;年龄18~74岁,平均57.1岁。统计分析肠外瘘损伤原因、损伤部位以及影响其治疗结局的相关因素。结果肠外瘘原因:胃肠道肿瘤手术21例,腹部创伤1例,消化道穿孔出血1例,胰腺疾病1例。肠外瘘部位:小肠瘘13例,其中高位瘘(十二指肠及距离十二指肠100cm以内的空肠)7例;结直肠瘘10例;胃穿孔部位瘘1例。患者的病情与肠外瘘发生部位、急性生理与慢性健康评分-Ⅱ(APACHE-Ⅱ)评分相关,高位小肠瘘及APACHE-Ⅱ重度评分是死亡独立相关因素,抢救失败率分别为42.9%和57.1%,而损害控制技术在其中起关键作用。结论肠外瘘致严重腹腔感染常合并多器官功能障碍等多种并发症,是导致患者死亡、治疗失败的重要原因,在把握再次手术适应证、围手术期准备、手术实施的过程中应用损害控制优势明显,值得推广应用。

Objective To investigate th effect of the damage control surgery used in the reoperation of complicated intra-abdomianl infection after enterocutaneous fistulas.Methods Retrospective study was conducted in the clinical data of 24 patients(aged 18-74 years)who needed reoperation due to severe abdominal infection in the period of Jun.2013 to Jan.2017 in the People s Hospital of Guangxi Zhuang Autonomous Region.Patients who had reoperation in other hospitals were excluded.There were 19 males and 5 females.The age ranged from 18 to 74 years,and the average age was 57.1 years.The causes and sites of enteral fistula injury and the related factors affecting the treatment outcome were analyzed statistically.Results The causes of the enterocutaneous fistulas were:21 cases of gastrointestinal tumor operation,1 case of abdominal trauma,and 1 case of gastrointestinal perforation and bleeding,1 case of pancreatic disease.The location of enterocutaneous fistula included 13 cases of small intestinal fistula,7 cases of high fistula(duodenum and jejunum within 100cm of duodenum),10 cases of straight intestinal fistula,and 1 case of gastric perforation site fistula.The final outcome of the patients was related to the location of the enterocutaneous fistula and APACHE-Ⅱscore.The high intestinal fistula and APACHE-Ⅱscore were the independent death related factors.The failure rate of rescue was 42.9%and 57.1%,respectively,and the damage control surgery played a key role.Conclusion Multiple organ dysfunction and other complications are often associated with complicated intra-abdominal infection after enterocutaneous fistulas,which is an important reason for the death and treatment failure of patients.It has obvious advantages in the application of damage control technology in the process of mastering the indications of reoperation,perioperative preparation and operation implementation,which is worth popularizing and applying.