Research Unit in Clinical Epidemiology, High Specialized Medical Unit, Mexican Institute of Social Security, José Enrique Rodo #2558, Colonia Prados Providencia, 44670, Guadalajara, Jalisco, Mexico.
World J Gastroenterol. 2010 Jun 14;16(22):2793-800. doi: 10.3748/wjg.v16.i22.2793.
To assess whether the use of fibrin sealant shortens the closure time of postoperative enterocutaneous fistulas (ECFs).
The prospective case-control study included 70 patients with postoperative ECFs with an output of < 500 mL/d, a fistulous tract of > 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support.
There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 +/- 14.2 d and 32.5 +/- 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 +/- 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 +/- 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition.
Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.
评估纤维蛋白胶是否能缩短术后肠外瘘（ECF）的闭合时间。
这是一项前瞻性病例对照研究，共纳入 70 例术后 ECF 患者，其输出量<500ml/d，瘘管>2cm，且无局部并发症。将患者分为研究组（n=23）和对照组（n=47）。通过内镜可视化监测食管、胃和肠瘘，也可以直接通过外部孔道应用纤维蛋白胶。观察指标包括闭合时间、恢复口服喂养时间和与营养支持相关的发病率。
两组患者的平均年龄、瘘管输出量和随访时间无差异。研究组所有患者的闭合时间为 12.5+/-14.2d，对照组为 32.5+/-17.9d（P<0.001），与营养支持相关的发病率分别为 8.6%和 42.5%（P<0.01）。在结肠瘘患者中，首次应用纤维蛋白胶后 23.5+/-19.5d 完全闭合，对照组自发闭合时间为 36.2+/-22.8d（P=0.36）。由于残留疾病，2 例患者出现复发。因与肠外营养相关的感染性并发症，每组各有 1 例患者死亡。
应用纤维蛋白胶可显著缩短闭合时间，更快恢复口服喂养。我们建议对稳定的肠外瘘采用纤维蛋白胶治疗。
