复杂肠瘘阶梯治疗及营养支持治疗策略

Stepwise treatment of complex intestinal fistulas and strategies of nutritional support treatment

肠瘘是腹部外科的常见疾病和并发症之一,在引起严重腹腔感染的同时出现梗阻、出血、营养不良,并发展为复杂肠瘘,导致治疗难度增加、治疗费用增加、患者病死率高等。目前,肠瘘的治疗主要以阶梯式的三段治疗为主:(1)早期诊断;(2)中期营养支持治疗;(3)后期确定性手术治疗。营养支持治疗能显著降低患者病死率,提高治愈率。由于肠瘘治疗具有困难性、复杂性和多样性,且复杂肠瘘是目前肠瘘治疗中的难点,因此本文将分别介绍不同阶段的进展和难点,并从跨学科合作的角度展望肠瘘未来治疗的方向。

Intestinal fistula is one of the common diseases and complications in abdominal surgery.It does not only cause severe abdominal infections but also leads to obstruction,bleeding,malnutrition,and may develop into complex intestinal fistulas,resulting in increased challenges in treatment,elevated treatment costs,and increased risk of patient mortality.At present,the treatment of intestinal fistula mainly adopts a three-stage approach:(1)early diagnosis,(2)mid-term nutritional support treatment,and(3)definitive surgical treatment.Nutritional support treatment can significantly reduce patient mortality and improve recovery.Due to the difficulty,complexity,and diversity of intestinal fistula treatment,and the fact that complex intestinal fistulas are currently a challenge in the treatment of intestinal fistulas,this article will introduce the progress and difficulties at different stages,and explore the future treatment direction of intestinal fistulas from the perspective of interdisciplinary cooperation.