1 Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
2 Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts, USA.
Nutr Clin Pract. 2017 Aug;32(4):508-515. doi: 10.1177/0884533617701402. Epub 2017 Mar 30.
An enterocutaneous fistula (ECF) is an aberrant connection between the gastrointestinal tract and the skin or atmosphere (enteroatmospheric fistula [EAF]). Multimodal treatment includes surgical procedures, nutrition support, and wound care. We evaluated our practice and compared our outcomes with previous results published from our institution.
We performed a retrospective analysis of hospitalized ECF/EAF patients admitted between January 2011 and November 2015. Patients with internal fistulas; active inflammatory bowel disease; malignancy; radiation treatment; end-stage renal, hepatic, or cardiac disease; and active alcoholism were excluded. Data collected included demographics, fistula characteristics, nutrition therapy, treatment, operative success, and hospital mortality. Parametric and nonparametric tests for independent and paired groups were performed.
Thirty-one patients were included in the analysis. The median (interquartile range) age was 60 (53-76) years, and 81% were female. Parenteral nutrition was initially prescribed in 80% of patients, but 61% received enteral nutrition (EN) at some point during their hospitalization. Two patients were fed by fistuloclysis. Eighty percent of the patients underwent surgical repair a median of 12 months after diagnosis with 92% operative success. Surgical repair had a modest correlation with home discharge (ρ = 0.517, P = .003). A large proportion of patients (77%) were discharged home. The in-hospital mortality at our institution decreased from 44% in 1960 to 21% in 1970 to 3% in the current study.
Modern treatment of ECF/EAF, including EN and advanced local wound care, is associated with improvements in clinical outcomes such as hospital mortality.
肠皮瘘（ECF）是胃肠道与皮肤或大气之间的异常连接（肠外瘘[EAF]）。多模式治疗包括手术、营养支持和伤口护理。我们评估了我们的实践，并将我们的结果与之前在我们机构发表的结果进行了比较。
我们对 2011 年 1 月至 2015 年 11 月期间住院的 ECF/EAF 患者进行了回顾性分析。排除有内瘘、活动性炎症性肠病、恶性肿瘤、放射治疗、终末期肾、肝或心脏疾病和活动性酒精中毒的患者。收集的数据包括人口统计学、瘘管特征、营养治疗、治疗、手术成功率和医院死亡率。对独立和配对组进行了参数和非参数检验。
31 例患者纳入分析。中位（四分位距）年龄为 60（53-76）岁，81%为女性。80%的患者最初接受了肠外营养，但61%的患者在住院期间接受了肠内营养（EN）。有 2 例患者通过瘘管输注喂养。80%的患者在诊断后 12 个月内接受了手术修复，92%的手术成功率。手术修复与家庭出院有一定的相关性（ρ=0.517，P=0.003）。很大一部分患者（77%）出院回家。我们机构的住院死亡率从 1960 年的 44%降至 1970 年的 21%，再降至目前的 3%。
包括 EN 和先进的局部伤口护理在内的现代 ECF/EAF 治疗方法与改善临床结局相关，如医院死亡率。
