十二指肠瘘伴腹腔感染的手术治疗

Surgical treatment of duodenal fistula with intra-abdominal infection

目的探讨十二指肠瘘伴腹腔感染的外科治疗方法。方法回顾性分析2015年1月至2021年12月在郑州大学附属肿瘤医院治疗的19例十二指肠瘘患者的临床资料,手术方式为十二指肠造瘘术或改良十二指肠旷置术。结果19例患者均伴有腹腔感染,其中十二指肠残端瘘9例。所有患者均顺利完成手术,行十二指肠造瘘11例,改良十二指肠旷置术8例,中位手术时间110(60~140)min,术后中位住院时间29(9~103)d。术后死亡2例,其余患者瘘口均愈合,治疗有效率达90%(17/19)。结论外科干预十二指肠瘘应着重感染源控制、加强肠腔及腹腔引流,减少术后并发症的发生。

Object To explore surgical treatments for duodenal fistula with intra-abdominal infection.Methods The data of 19 patients with duodenal fistula treated at the Affiliated Tumor Hospital of Zhenzhou University between Jan 2015 and Dec 2021 were analyzed retrospectively.Surgery is performed with duodenostomy or modified duodenal shunt procedures.Result All patients were accompanied by intra-abdominal infection,including 9 duodenal stump fistulas.All patients successfully completed the operation,11cases underwent duodenostomy,8 case underwent modified duodenal shunt procedures.operating time was 110(60-140)min,postoperative hospitalization time was 29(9-103)d.Two patients died postoperatively.Fistula heals in other patients.Conclusion Surgical intervention for duodenal fistula should focus on controlling the source of infection,strengthening intestinal and abdominal drainage,and reducing postoperative complications.