Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany.
Int J Colorectal Dis. 2011 Mar;26(3):303-11. doi: 10.1007/s00384-010-1104-5. Epub 2010 Dec 29.
Fistulae or leakages of anastomotic junctions of the gastrointestinal tract used to be an indication for surgery. However, patients often are severely ill and endoscopic therapeutic options have been suggested to avoid surgical intervention.
This is a retrospective analysis of fibrin glue application in the treatment of gastrointestinal fistulae or anastomotic leakages.
The aim of this study was to investigate the value of fibrin glue in the treatment of gastrointestinal fistulae and leakages.
From September 1996 to November 2002, 52 patients with gastrointestinal fistulae or insufficiencies have been treated endoscopically including the use of fibrin glue (Tissucol Duo S®, Baxter, Unterschleissheim, Germany). Clinical data comprising concomitant therapies and results were analysed by chart review.
Twenty-six lesions were located in the oesophagus or gastroesophageal junction, 4 in the stomach, 7 in the small intestine, 13 colorectal and 2 in the pancreas. The duration of treatment ranged from 12 to 1,765 days. Two to 81 ml fibrin glue (median 8.5) was used in 1-40 sessions (median 4). All patients received antibiotics; additional endoscopic options were frequently applied. Endoscopic therapy cured 55.7% patients (n = 29); 36.5% (n = 19) were cured with fibrin glue as sole endoscopic option. In 23.1% (n = 12), surgical intervention became necessary. Patients without major infectious complications tended to have a higher cure rate without surgery (87.5% vs. 50%). Eleven patients died (21.1%).
Endoscopic therapy is a valuable option in the treatment of fistulae and anastomotic insufficiencies of the gastrointestinal tract. It usually is applied repeatedly. Fibrin glue is a mainstay of this procedure. Major infectious complications seem to define a subgroup of patients with poorer outcome.
胃肠道吻合口瘘或漏曾经是手术的指征。然而，患者通常病情严重，内镜治疗方法已被建议用于避免手术干预。
这是一项关于纤维蛋白胶在治疗胃肠道瘘或吻合口漏中的应用的回顾性分析。
本研究旨在探讨纤维蛋白胶在治疗胃肠道瘘和漏中的价值。
从 1996 年 9 月至 2002 年 11 月，52 例胃肠道瘘或不足的患者接受了内镜治疗，包括使用纤维蛋白胶（Tissucol Duo S ® ，Baxter，Unterschleissheim，德国）。通过病历回顾分析了包括伴随治疗和结果在内的临床数据。
26 处病变位于食管或胃食管交界处，4 处位于胃，7 处位于小肠，13 处位于结直肠，2 处位于胰腺。治疗时间从 12 天到 1765 天不等。在 1-40 次治疗中使用了 2-81ml 纤维蛋白胶（中位数 8.5）。所有患者均接受抗生素治疗；经常应用其他内镜治疗方法。内镜治疗治愈了 55.7%的患者（n=29）；36.5%（n=19）的患者仅使用纤维蛋白胶作为单一内镜治疗方法治愈。在 23.1%（n=12）的患者中，需要进行手术干预。无重大感染并发症的患者倾向于无需手术即可获得更高的治愈率（87.5% vs. 50%）。11 名患者死亡（21.1%）。
内镜治疗是治疗胃肠道瘘和吻合口不足的一种有价值的选择。它通常需要反复进行。纤维蛋白胶是该治疗的主要方法。严重的感染并发症似乎定义了预后较差的患者亚组。
