Schwartz R W, Barker D E, Griffen W O, Ross C B, Strodel W E
Department of Surgery, University of Kentucky Chandler Medical Center, Lexington.
Am Surg. 1989 Jan;55(1):50-4.
Current operative treatment for intra-abdominal sepsis secondary to internal gastrointestinal fistulas is aimed at wide drainage of septic foci and elimination of continued peritoneal soilage. Although methods for surgical drainage of abscesses and fistulous tracts are well established, the optimal method for surgical prevention of continued peritoneal soilage remains controversial. The authors applied the principle of complete gastrointestinal disconnection and performed diversion of the gastrointestinal tract and tube decompression proximal to the fistulous opening in the treatment of 22 critically ill patients with intra-abdominal sepsis from gastric or small bowel fistulas. Patient survival varied according to the level of the site of gastrointestinal leakage. All patients (5 out of 5) who had leakage in the distal small bowel survived. Six of nine (66%) patients with leakage from the proximal jejunum and six of eight (75%) of patients with gastroduodenal leakage survived. The overall survival rate of 77 per cent observed in this group of patients supports the authors' hypothesis that complete gastrointestinal disconnection is a valuable adjunct in the treatment of these severely ill patients.
目前针对因胃肠道内瘘继发的腹腔内感染的手术治疗旨在对感染灶进行广泛引流，并消除持续的腹腔污染。尽管脓肿和瘘管的手术引流方法已很成熟，但预防腹腔持续污染的最佳手术方法仍存在争议。作者应用完全胃肠道离断的原则，对22例因胃或小肠瘘导致腹腔内感染的危重症患者进行了瘘口近端的胃肠道转流和管腔减压治疗。患者的生存率因胃肠道漏出部位的不同而有所差异。所有远端小肠漏出的患者（5例中的5例）均存活。空肠近端漏出的9例患者中有6例（66%）存活，胃十二指肠漏出的8例患者中有6例（75%）存活。该组患者77%的总生存率支持了作者的假设，即完全胃肠道离断是治疗这些重症患者的一种有价值的辅助手段。
