Dubose Joseph J, Lundy Jonathan B
R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Air Force Center for Sustainment of Trauma Readiness Skills, Baltimore, Maryland.
Clin Colon Rectal Surg. 2010 Sep;23(3):182-9. doi: 10.1055/s-0030-1262986.
One of the most devastating complications to develop in the general surgical patient is an enterocutaneous fistula (ECF). Critically ill patients suffering trauma, thermal injury, infected necrotizing pancreatitis, and other acute intraabdominal pathology are at unique risk for this complication as well. By using decompressive laparotomy for abdominal compartment syndrome and leaving the abdomen open temporarily for other acute processes, survival in some instances may be improved. However, the exposed viscera are at risk for fistulization in the presence of an open abdomen, a newly defined entity termed the enteroatmospheric fistula (EAF). The purpose of this article is to describe the epidemiology of ECF in the setting of trauma and critical illness, nutrition in injured/critically ill patients with ECF, pharmacologic adjuncts to decrease fistula effluent, wound care, surgical management of the EAF/ECF, and techniques for prevention of these dreaded complications in patients with an open abdomen.
肠皮肤瘘（ECF）是普通外科患者最具破坏性的并发症之一。遭受创伤、热损伤、感染性坏死性胰腺炎及其他急性腹部病变的重症患者也面临着发生这种并发症的独特风险。通过对腹腔间隔室综合征进行减压剖腹术，并因其他急性病情而暂时敞开腹部，在某些情况下可提高生存率。然而，在腹部敞开的情况下，暴露的内脏有发生瘘管形成的风险，这是一种新定义的实体，称为肠气瘘（EAF）。本文旨在描述创伤和危重病情况下ECF的流行病学、患有ECF的受伤/重症患者的营养、减少瘘管流出物的药物辅助治疗、伤口护理、EAF/ECF的手术管理，以及预防腹部敞开患者发生这些可怕并发症的技术。
