Havel E, Sobotka L, Bedrna J, Hladík P, Manák J, Bláha V, Adámek P, Vyroubal P, Zadák Z
Chirurgická klinika Lékarské fakulty UK a FN, Hradec Králové.
Vnitr Lek. 2003 Aug;49(8):684-8.
An acute operation was made on a 56-year woman for inflammatory perforation of colon. A series of repeated operations followed due to relapsing iatrogenic intestinal fistula and peritonitis. From the day 70 the patient was treated at the Intensive Metabolic Care Unit of the Gerontological and Metabolic Clinic of Faculty Hospital in Hradec Králové. Having cured the septic shock the authors prepared the patient to a reconstruction operation on alimentary tract by administering parenteral nutrition, treating the wounds and by motion rehabilitation. From day 150 on the patient was treated with low doses of enteral nutrition into the segment of intestine between the fistulas, in connection with the subsequent decrease of two-month lasting hyperbilirubinemia of 200-260 mumol/l. A successful reconstruction of the alimentary tract was performed on the day 205 of the treatment with the time lapse of 146 days after the last surgical intervention. A three-fold anastomosis on small intestine and a resection of the fistula on the transversal colon was made. The post-operation fistula was healed-up conservatively, while the parenteral nutrition continued, as verified on day 246 by enteroclysis. The paper draws attention to the importance of conservative metabolic care in the therapy of dishiscences of intestinal anastomoses not treated by acute surgery in time. A favourable additive effect of enteral nutrition on the persisting cholestasis during parenteral nutrition is discussed.
对一名56岁女性进行了急性手术，治疗结肠炎性穿孔。由于复发性医源性肠瘘和腹膜炎，随后进行了一系列反复手术。从第70天起，患者在赫拉德茨克拉洛韦市大学医院老年病与代谢诊所的强化代谢护理病房接受治疗。在治愈感染性休克后，作者通过给予肠外营养、治疗伤口和进行运动康复，为患者准备消化道重建手术。从第150天起，对患者在瘘管之间的肠段给予低剂量肠内营养，同时两个月持续存在的200 - 260μmol/l高胆红素血症有所下降。在治疗第205天，即最后一次手术干预146天后，成功进行了消化道重建。进行了小肠三重吻合术和横结肠瘘切除术。术后瘘管经保守治疗愈合，同时继续进行肠外营养，在第246天经小肠灌肠证实。本文提请注意在未及时进行急性手术治疗的肠吻合口裂开治疗中，保守代谢护理的重要性。讨论了肠内营养对肠外营养期间持续胆汁淤积的有利附加作用。
