Dorta G
Division of Gastroenterology CHUV/PMU, University Hospital, Lausanne, Switzerland.
Digestion. 1999;60 Suppl 2:53-6. doi: 10.1159/000051481.
Intestinal fistulae usually arise as a complication of abdominal surgery. Its treatment is complex and intestinal fistula-related morbidity and mortality is high. Fistula closure rates under conservative medical treatment vary between 24 and 72%. Octreotide and somatostatin reduce gastrointestinal, biliary and pancreatic secretion and increase intestinal water and electrolyte absorption. In recent years, octreotide and somatostatin have been associated with conservative medical treatment for patients with intestinal fistulae. Four placebo-controlled studies have been published within the past 6 years. The interpretation of their results is difficult because patient collectives were small and heterogeneous. In one study, somatostatin decreased fistula-related complications when compared to placebo, and in another study, octreotide decreased the healing time of intestinal fistulae and the time patients required total parenteral nutrition when compared to placebo. In contrast, the fistula closure rate, hospitalization time and mortality were not influenced by the use of octreotide or somatostatin in conservative medical treatment. In conclusion, octreotide and somatostatin actually cannot be recommended in the treatment of intestinal fistulae in settings outside of controlled trials.
肠瘘通常作为腹部手术的并发症出现。其治疗复杂，且与肠瘘相关的发病率和死亡率很高。保守药物治疗下的瘘管闭合率在24%至72%之间。奥曲肽和生长抑素可减少胃肠道、胆道和胰腺的分泌，并增加肠道对水和电解质的吸收。近年来，奥曲肽和生长抑素已与肠瘘患者的保守药物治疗相关联。在过去6年内已发表了四项安慰剂对照研究。由于患者群体规模小且异质性大，对其结果的解读很困难。在一项研究中，与安慰剂相比，生长抑素减少了与瘘管相关的并发症；在另一项研究中，与安慰剂相比，奥曲肽缩短了肠瘘的愈合时间以及患者所需的全胃肠外营养时间。相比之下，在保守药物治疗中使用奥曲肽或生长抑素并未影响瘘管闭合率、住院时间和死亡率。总之，在对照试验之外的情况下，实际上不推荐使用奥曲肽和生长抑素治疗肠瘘。
