Wainstein Daniel Edgardo, Fernandez Ernesto, Gonzalez Daniel, Chara Osvaldo, Berkowski Dario
Cirugía General, Hospital E. Tornú Ex Combatientes de Malvinas 3002, Ciudad de Buenos Aires, 1427, Argentina.
World J Surg. 2008 Mar;32(3):430-5. doi: 10.1007/s00268-007-9235-8.
Enterocutaneous fistulas arise as complications in 0.8%-2% of abdominal operations. The global mortality rate is 5%-37%, yet it may exceed 60% in the case of high-output fistulas and when sepsis and malnutrition are involved. The objective of this prospective cohort study with retrospective data analyses was to analyze our ten-year experience with a vacuum-compaction device for the management of high-output, postoperative enterocutaneous fistulas at the Department of General Surgery, E. Tornú Hospital, and the Intensive Care Unit, Churruca Hospital, Buenos Aires, Argentina.
Ninety-one patients presented 179 fistulas; 73 (69.2%) were men whose mean age was 48 years. Sepsis and malnutrition were present in 66 (72.5%). The mean initial fistula output was 1,485 ml/day. Conservative management was carried out according to diagnostic and therapeutic priority staging. A vacuum-compaction system (SIVACO; Spanish acronym) was used to control output.
Output was entirely suppressed in 37 (40.7%) patients after 1-7 days of treatment, and reduced to less than 500 ml/day (average=138) in 52 (57.1%) patients. Spontaneous closure was achieved in 42 (46.2%) patients, whereas 37 (40.7%) patients did not improve after 20-380 (average=111) days of treatment. Those patients required surgical correction, which had an 83.8% success rate. Overall mortality was 16.5% (15 patients).
The vacuum-compaction device proved effective for reducing fistula output in 89 of 91 patients (97.8%).
肠皮肤瘘是腹部手术中0.8%-2%的并发症。全球死亡率为5%-37%，然而在高流量瘘以及伴有脓毒症和营养不良的情况下，死亡率可能超过60%。这项具有回顾性数据分析的前瞻性队列研究的目的是分析我们在阿根廷布宜诺斯艾利斯E. Tornú医院普通外科和Churruca医院重症监护病房使用真空压缩装置管理高流量术后肠皮肤瘘的十年经验。
91例患者出现179个瘘；73例（69.2%）为男性，平均年龄48岁。66例（72.5%）存在脓毒症和营养不良。初始瘘平均每日排出量为1485毫升。根据诊断和治疗优先分期进行保守治疗。使用真空压缩系统（SIVACO；西班牙语首字母缩写）控制排出量。
37例（40.7%）患者在治疗1-7天后排出量完全得到控制，52例（57.1%）患者排出量减少至每日少于500毫升（平均为138毫升）。42例（46.2%）患者实现了自发闭合，而37例（40.7%）患者在治疗20-380天（平均为111天）后病情未改善。这些患者需要手术矫正，成功率为83.8%。总死亡率为16.5%（15例患者）。
事实证明，真空压缩装置对91例患者中的89例（97.8%）减少瘘排出量有效。
