Oshiro Taihei, Moriura Shigeaki, Yoshioka Yuichiro, Kawahara Mari, Kobayashi Ichiro, Matsumoto Takatoshi
Department of Surgery, Yachiyo Hospital, Anjo, Aichi 446-8510, Japan.
Surg Today. 2006;36(10):941-3. doi: 10.1007/s00595-006-3258-x.
A new approach to closing a malignant enterocutaneous fistula is reported. Transverse colon cancer recurred around the superior mesenteric vein along with a duodenocutaneous fistula, thus causing severe dermatitis. The tumor was partially resected at the fascia level and the fistula measured 2.5 cm in diameter. A left rectus abdominis musculocutaneous flap failed to close the fistula because of graft necrosis. A jejunal flap measuring 8 cm in length was prepared by sacrificing about 15 cm of adjacent jejunum to create the pedicle. The mucosal layer of the flap was removed and the fistula was closed, then the tumor surface was covered. Two weeks later, the skin defect was covered with free skin grafting. The patient died of cancer 6 months after surgery, but there was no recurrence of the fistula.
报道了一种闭合恶性肠皮肤瘘的新方法。横结肠癌在上肠系膜静脉周围复发并伴有十二指肠皮肤瘘，从而导致严重的皮炎。肿瘤在筋膜层面进行了部分切除，瘘管直径为2.5厘米。左腹直肌肌皮瓣因移植坏死未能闭合瘘管。通过牺牲约15厘米相邻空肠制备了一个长8厘米的空肠瓣以形成蒂部。切除瓣的黏膜层并闭合瘘管，然后覆盖肿瘤表面。两周后，通过游离植皮覆盖皮肤缺损。患者术后6个月死于癌症，但瘘管未复发。
