Martinez Jose L, Luque-de-Leon Enrique, Mier Juan, Blanco-Benavides Roberto, Robledo Felipe
General and Gastrointestinal Surgery, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc #330, Col. Doctores, Deleg. Cuauhtémoc, 06725 México, D.F, México.
World J Surg. 2008 Mar;32(3):436-43; discussion 444. doi: 10.1007/s00268-007-9304-z.
Most enterocutaneous fistulas are postoperative in origin. Sepsis, malnutrition, and hydroelectrolytic deficit are still the most important complications to which patients with postoperative enterocutaneous fistulas (PEF) are exposed. Knowledge of prognostic factors related to specific outcomes is essential for therapeutic decision-making processes.
We reviewed files of all consecutive patients with PEF treated in our hospital during a 10-year period. Our aim was to identify factors related to spontaneous closure, need for operative treatment, and mortality. Univariate and multivariate analyses were performed.
A total of 174 patients were treated. The most frequent site of origin was the small bowel (90 patients: 48 jejunal, and 42 ileal), followed in frequency by the colon (50 patients). Postoperative enterocutaneous fistula closure was achieved in 151 patients (86%), being spontaneous in 65 (37%) and surgical in 86 (49%). Factors that significantly precluded spontaneous closure were jejunal site, multiple fistulas, sepsis, high output, and hydroelectrolytic deficit at diagnosis or referral. Origin of PEF at our hospital was the only factor significantly associated with spontaneous closure. The most frequent operative indication was PEF persistence without sepsis. Factors significantly associated with the need for operative treatment were high output, jejunal site, and multiple fistulas. Closure was achieved in 84% of patients who underwent operation. A total of 23 patients died (13%). Factors associated with mortality were serum albumin <3.0 g/dl (at diagnosis or referral), high output, hydroelectrolytic deficit, multiple fistulas, jejunal site, sepsis, and a complex fistulous tract.
In spite of advances in management of PEF, the associated morbidity and mortality remain high. Among several variables influencing outcome, our multivariate analysis disclosed high output, jejunal site, multiple fistulas, and sepsis as independent adverse factors related to non-spontaneous closure, need for operative treatment, and/or death.
大多数肠造口瘘源于术后。脓毒症、营养不良和水电解质缺乏仍是术后肠造口瘘（PEF）患者面临的最重要并发症。了解与特定结局相关的预后因素对于治疗决策过程至关重要。
我们回顾了我院10年间连续治疗的所有PEF患者的病历。我们的目的是确定与自发闭合、手术治疗需求和死亡率相关的因素。进行了单因素和多因素分析。
共治疗174例患者。最常见的起源部位是小肠（90例患者：48例空肠，42例回肠），其次是结肠（50例患者）。151例患者（86%）实现了术后肠造口瘘闭合，其中65例（37%）为自发闭合，86例（49%）为手术闭合。显著阻碍自发闭合的因素为空肠部位、多发瘘、脓毒症、高流量以及诊断或转诊时的水电解质缺乏。我院的PEF起源是与自发闭合显著相关的唯一因素。最常见的手术指征是无脓毒症的PEF持续存在。与手术治疗需求显著相关的因素是高流量、空肠部位和多发瘘。接受手术的患者中有84%实现了闭合。共有23例患者死亡（13%）。与死亡率相关的因素包括血清白蛋白<3.0 g/dl（诊断或转诊时）、高流量、水电解质缺乏、多发瘘、空肠部位、脓毒症和复杂的瘘管。
尽管PEF的管理取得了进展，但其相关的发病率和死亡率仍然很高。在影响结局的多个变量中，我们的多因素分析显示高流量、空肠部位、多发瘘和脓毒症是与非自发闭合、手术治疗需求和/或死亡相关的独立不良因素。
