González-Ojeda A, Avalos-González J, Muciño-Hernández M I, López-Ortega A, Fuentes-Orozco C, Sánchez-Hochoa M, Anaya-Prado R, Arenas-Márquez H
Medical Research Unit in Clinical Epidemiology. Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.
Endoscopy. 2004 Apr;36(4):337-41. doi: 10.1055/s-2004-814412.
Gastrocutaneous fistulas are infrequent after gastrostomy tube removal. However, if the fistulous tract remains permeable, even low-volume output can produce significant cutaneous burns. The use of biodegradable adhesives has been described, where fibrin glue is applied directly over the fistulous tract or under the guidance of procedures such as upper or lower gastrointestinal endoscopy or fistuloscopy. We studied the use of fibrin glue in five consecutive adult patients with gastrocutaneous fistulas after gastrostomy tube removal, with no complications that might impede spontaneous closure. A comparison group included seven patients treated during the preceding 2 years with conservative medical management, who were not treated with fibrin glue. There was no difference between the two groups with regard to age and gender, nor with regard to type of gastrostomy (surgical or endoscopic). The mean output volume from the fistulas was 151.4 +/- 146.1 ml/24 h in the study group and 115.0 +/- 42.7 ml/24 h in the control group, which was not significantly different ( P = 0.80). The duration of previous conservative treatment was 93.8 +/- 85.1 days for the study group and 95.8 +/- 80.7 days for the control group and this also did not differ significantly ( P = 0.93). The time to achieve total fistula closure was 7.0 +/- 3.1 days in the study group and 32.7 +/- 15.7 days in the control group. This difference was statistically significant ( P < 0.004). The time required before oral feeding could be recommenced after spontaneous or induced closure was similar in the two groups, at 2.8 +/- 1.3 days and 4.71 +/- 2.36 days, respectively. Endoscopic guidance allows direct instillation of fibrin glue via the external opening through the whole fistulous tract. This procedure reduces the time required for the closure of gastrocutaneous fistulas.
胃造瘘管拔除后发生胃皮肤瘘并不常见。然而，如果瘘道仍然通畅，即使是少量的引流液也可能导致严重的皮肤灼伤。已有使用生物可降解粘合剂的报道，即直接在瘘道上或在上消化道或下消化道内镜检查或瘘管镜检查等操作的引导下应用纤维蛋白胶。我们研究了连续5例胃造瘘管拔除后发生胃皮肤瘘的成年患者使用纤维蛋白胶的情况，这些患者没有可能妨碍自然闭合的并发症。一个对照组包括前两年接受保守药物治疗的7例患者，他们未使用纤维蛋白胶。两组在年龄、性别以及胃造瘘类型（手术造瘘或内镜造瘘）方面均无差异。研究组瘘管的平均引流量为151.4±146.1 ml/24小时，对照组为115.0±42.7 ml/24小时，差异无统计学意义（P = 0.80）。研究组先前保守治疗的持续时间为93.8±85.1天，对照组为95.8±80.7天，差异也无统计学意义（P = 0.93）。研究组瘘管完全闭合的时间为7.0±3.1天，对照组为32.7±15.7天。这一差异具有统计学意义（P < 0.004）。两组在自然闭合或诱导闭合后重新开始经口喂养所需的时间相似，分别为2.8±1.3天和4.71±2.36天。内镜引导可通过外部开口将纤维蛋白胶直接注入整个瘘道。该操作缩短了胃皮肤瘘闭合所需的时间。
