Lauro A, Cirocchi R, Cautero N, Dazzi A, Pironi D, Di Matteo F M, Santoro A, Faenza S, Pironi L, Pinna A D
G Chir. 2017 Jul-Aug;38(4):185-198. doi: 10.11138/gchir/2017.38.4.185.
A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas).
The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure.
The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation.
Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.
对肠造口瘘（ECF）修复及早期复发情况进行了一项综述，并纳入了我们的20例成年患者（65%有多处瘘管）。
检索到4098篇文章，但仅有15篇相关：1217例患者接受了手术。瘘管诊断至手术修复的间隔时间为3个月至1年。1048例患者进行了肠切除并一期吻合，192例（18.3%）进行了覆盖造口：856例患者（81.7%）在一次手术中进行了瘘管切除。
患者的复发率为14.3%，死亡率为13.1%。根据我们的经验，75%的患者在瘘管出现后1年及以上时间接受了手术治疗：手术创伤很大（40%的患者残余小肠不足100 cm）。我们进行了手工缝合吻合的肠切除（95%），未设置临时造口。住院死亡率为0%，出院时所有患者均恢复经口进食，早期再发瘘管率为0%。
文献支持我们的经验：从瘘管出现起经过3个月至1年的充分恢复期后，可安全地进行ECF切除。在我们的系列研究中，一期修复（肠切除加吻合手术，不设临时造口）避免了早期复发且无死亡病例。
