Schildberg C W, Raptis D, Langheinrich M, Hohenberger W, Horbach T
Chirurgie, Universitätsklinikum Erlangen, Deutschland.
Chirurgie, Schön Klinik Nürnberg/Fürth, Erlangen, Deutschland.
Zentralbl Chir. 2016 Apr;141(2):210-4. doi: 10.1055/s-0035-1558091. Epub 2015 Nov 16.
The manifestation of enterocutaneous fistulas is varied. They can range from controlled secretion via the abdominal wall to septic disease. The disease is categorised into low-, moderate- and high-output fistulas. Often the only option is surgical treatment. Occasionally, there is spontaneous healing under conservative treatment. The aim of this study was to work out a possible subgroup of patients who benefit from conservative treatment. Material und Methods: Ninety-nine patients were treated for enterocutaneous fistulas from 1 January 1995 to 31 December 2005. Seventy patients underwent surgery, 29 patients were treated conservatively. All data was collected prospectively using an admission form and was analysed retrospectively. Conservative treatment consisted of fasting with parenteral nutrition, while fistulas in the surgical group were treated by suture repair or resection. Additive treatments such as vacuum dressings or TNF-α medication for patients with Crohn's disease were not performed.
In our study we achieved a total cure rate of 69%, with an average hospital stay of 38 days. Surgical treatment led to significantly better results compared with conservative treatment (83 vs. 34%). Mortality in the surgical group was distinctly, but not significantly reduced at 7%, compared with 14% in the conservative group. The fistulas that healed after conservative treatment were low-output fistulas only.
Enterocutaneous fistulas are diseases associated with long hospital stays and, therefore, expensive treatment. Low-output fistulas may heal spontaneously. The best results are achieved by surgical treatment. More recent treatments such as vacuum therapy and TNF-α medication for patients with Crohn's disease are promising approaches. In the future, many of these will have to be combined with surgical treatment.
肠皮肤瘘的表现多种多样。从通过腹壁的可控分泌物到脓毒症，范围不一。该疾病分为低、中、高流量瘘。通常唯一的选择是手术治疗。偶尔，在保守治疗下会出现自愈。本研究的目的是找出可能从保守治疗中获益的患者亚组。
1995年1月1日至2005年12月31日期间，对99例肠皮肤瘘患者进行了治疗。70例患者接受了手术，29例患者接受了保守治疗。所有数据均使用入院表格前瞻性收集，并进行回顾性分析。保守治疗包括禁食及肠外营养支持，而手术组的瘘则通过缝合修复或切除进行治疗。未对克罗恩病患者进行诸如负压敷料或肿瘤坏死因子-α药物等辅助治疗。
在我们的研究中，总治愈率为69%，平均住院时间为38天。与保守治疗相比，手术治疗取得了显著更好的效果（83%对34%）。手术组死亡率明显降低，但未达到显著水平，为7%，而保守组为14%。保守治疗后愈合的瘘仅为低流量瘘。
肠皮肤瘘是一种住院时间长且治疗费用高的疾病。低流量瘘可能会自愈。手术治疗效果最佳。诸如针对克罗恩病患者的负压治疗和肿瘤坏死因子-α药物等最新治疗方法是很有前景的途径。未来，其中许多方法将不得不与手术治疗相结合。
