生长抑素与生长激素治疗肠外瘘——方法与策略的改进

Somatostatin and growth hormone in the management of gastrointestinal fistulas-improved methods and changing decision

目的 研究生长抑素和生长激素在肠外瘘治疗中的作用与方法及其对现行肠外瘘治疗方法与策略的改进。方法 1996年以来收治的 388例肠外瘘病人 ,84例接受了早期快速自行愈合疗法。 35例病人接受了早期确定性手术。结果 在快速自行愈合组 ,80例成功自愈。其中单纯生长抑素组共 2 4例 ,2 1例自行愈合(87 5 % )。生长抑素加生长激素组 6 0例 ,5 9例成功自愈 (98 3% )。单纯生长抑素组平均自愈时间为 (33 0±31 5 )天。生长抑素加生长激素组平均自愈时间 (2 8 8± 18 5 )天。行早期确定性手术的 35例病人均存活 ,其中4例术后发生吻合口再漏 ,经冲洗引流后均自行愈合。结论 生长抑素和生长激素在肠外瘘发生后序贯使用 ,可提高肠外瘘的自行愈合率。对早期肠外瘘可试行早期确定性手术 ,在围手术期加用生长激素 。

Objective To investigate the role of somatostatin and growth hormone in the management of gastrointestinal fistulas.Methods Since 1996,388 patients complicated with gastrointestinal fistulas were treated,84 patients received spontaneous closure therapy,35 patients received early resection of fistulas.Results Eighty of 84 patients receiving spontaneous closure therapy were cured without operation.Twenty one of 24 patients receiving somatostatin were cured within average (33 0±31 5) days while 59 of 60 patients receiving somatostatin and growth hormone sequentially were cured successfully within (28 8±18 5) days.35 patients receiving early resection of fistulas recovered including 4 patients developing fistula again after reoperation.Conclusion Somatostatin and growth hormone can improve the cure rate of gastrointestinal fistula patients and reduce treatment time.Early resection of fistula can be performed in early developed fistula patients with the appropriate use of growth hormone.