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[术后肠瘘]

[Postoperative intestinal fistulae].

作者信息

Georgescu I, Nemeş R, Ghelase F, Vâlcea V, Surlin V, Martin L

机构信息

Clinica I Chirurgie Craiova.

出版信息

Chirurgia (Bucur). 2000 May-Jun;95(3):267-71.

Abstract

58 (6.25%) intestinal fistulae raised after 928 operations performed for varied surgical small bowel diseases were studied. The primary operation was performed for bowel obstruction, acute peritonitis, small bowel tumours, postoperative eviscerations and for entro-mesenteric infarction. We also noticed that the surgery was performed for the small bowel diseases in 47 (81%) acses and for the diseases belonging to other abdominal viscera in the rest, having an emergency character in 81% of cases. The small bowel fistulae were single (51 cases) or multiple having the following topographic distribution: jejunal fistulae in 25 (43.4%) cases and ileal fistulae in 33 cases (56.6). The coming out of the fistulae was directly in 41 (70%) cases and trough an intermediate route in 17 (30%) cases. The onset of the fistulae was certainly pointed by the coming out moment, early only in 39.6% of cases. This underlining the importance of an active exploration of the operative wound, imposed by the general and/or local premonitory symptoms. The treatment was complex, using conservative and/or surgical procedures; 23 (39.6%) patients were operated on. The mortality rate was of 29.4%. The parenteral nutrition and the therapeutical option for the conservative methods were the main therapeutical acquisitions, which improved the results and the prognosis of the intestinal fistulae.

摘要

对928例因各种外科小肠疾病进行手术治疗后出现的58例(6.25%)肠瘘进行了研究。初次手术是针对肠梗阻、急性腹膜炎、小肠肿瘤、术后脏器脱出和肠-肠系膜梗死进行的。我们还注意到,47例(81%)患者的手术是针对小肠疾病进行的,其余患者的手术是针对其他腹部脏器疾病进行的,81%的病例具有急诊性质。小肠瘘为单发(51例)或多发,其部位分布如下:空肠瘘25例(43.4%),回肠瘘33例(56.6%)。41例(70%)瘘口直接引出,17例(30%)经中间途径引出。瘘口的出现时刻可明确瘘口的发生,仅39.6%的病例为早期出现。这突出了根据全身和/或局部先兆症状积极探查手术切口的重要性。治疗方法复杂,采用保守和/或手术方法;23例(39.6%)患者接受了手术治疗。死亡率为29.4%。肠外营养和保守治疗方法的治疗选择是主要的治疗进展,改善了肠瘘的治疗效果和预后。

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