Saillen P, Mosimann F, Friedlender J
Service de chirurgie, CHUV, Suisse.
J Chir (Paris). 1991 Jun-Jul;128(6-7):290-3.
Aorto-enteric fistulae are primary or secondary. The primary variant is the rupture of an aortic aneurysm into the gastro-intestinal tract. The secondary fistulae are complications of reconstructive aortic surgery. We report our experience with 12 aorto-enteric fistulae (2 primary and 10 secondary) treated from 1971 to 1989. All patients presented with gastro-intestinal bleeding and the fistula was to the duodenum (3), jejunum (8) or appendix (1). In the secondary patients, a mean of 5 years had elapsed since the aortic replacement. In addition to closure of the enteric defect, three types of treatment were applied: excision of the old prosthesis, infrarenal aortic closure and axillo-bifemoral bypass (5); insertion of a new graft (3) and local repair (3). A patient was not treated due to a triple carcinoma. Hospital mortality was 50%. We conclude that the diagnosis of aortoenteric fistula is difficult and that the mortality is high. The operative management remains imperfect and a subject of controversy. Prevention and early detection request more attention than in the past.
主动脉肠瘘分为原发性和继发性。原发性主动脉肠瘘是指主动脉瘤破裂进入胃肠道。继发性瘘是主动脉重建手术的并发症。我们报告了1971年至1989年期间治疗的12例主动脉肠瘘（2例原发性和10例继发性）的经验。所有患者均表现为胃肠道出血，瘘口位于十二指肠（3例）、空肠（8例）或阑尾（1例）。继发性患者中，主动脉置换术后平均已过去5年。除了关闭肠道缺损外，还采用了三种治疗方法：切除旧的人工血管、肾下腹主动脉闭合和腋-双股动脉旁路移植术（5例）；植入新的移植物（3例）和局部修复（3例）。一名患者因患三联癌未接受治疗。医院死亡率为50%。我们得出结论，主动脉肠瘘的诊断困难，死亡率高。手术治疗仍不完善，是一个有争议的话题。与过去相比，预防和早期发现需要更多关注。
