Peck J J, Eidemiller L R
Department of Surgery, Good Samaritan Hospital, Portland, Ore.
Arch Surg. 1992 Oct;127(10):1191-3; discussion 1193-4. doi: 10.1001/archsurg.1992.01420100049008.
During an 11-year period ending in December 1991, 36 patients with aortoenteric fistulas were assessed and treated. Twenty-five patients (69%) had previously undergone aortic reconstruction with Dacron grafts, and 11 (31%) had spontaneous aortoenteric fistulas. Of the 25 patients with secondary fistulas, 14 (56%) had undergone aortic aneurysmal rupture or multiple aortic vascular reconstructions. Preoperative diagnosis was established in only 13 (36%) of 36 patients. Remote bypass preceding removal of the infected arterial prosthesis had the least morbidity and mortality. Three primary fistulas were found in unusual locations: aortocolonic, aortobronchial, and aortoesophageal. The patient with the aortoesophageal fistulas was the fifth survivor described in the literature. The overall mortality was 56%. A positive preoperative blood culture predicted a poor outcome. There were four amputations, there due to infection of the extra-anatomical bypass. Prompt directed assessment to ensure appropriately staged operative intervention should improve survival.
在截至1991年12月的11年期间，对36例主动脉肠瘘患者进行了评估和治疗。25例（69%）患者此前接受了涤纶人工血管主动脉重建术，11例（31%）为自发性主动脉肠瘘。在25例继发性瘘患者中，14例（56%）发生了主动脉瘤破裂或多次主动脉血管重建术。36例患者中仅13例（36%）术前确诊。在移除感染的动脉假体之前进行远端旁路手术的发病率和死亡率最低。发现3例原发性瘘位于不寻常部位：主动脉结肠瘘、主动脉支气管瘘和主动脉食管瘘。患有主动脉食管瘘的患者是文献中描述的第五例幸存者。总死亡率为56%。术前血培养阳性预示预后不良。有4例截肢，其中3例是由于解剖外旁路感染。及时进行有针对性的评估以确保适当的分期手术干预应能提高生存率。
