术后肠皮肤瘘：23例连续患者的治疗结果
Postoperative enterocutaneous fistulas: Management outcomes in 23 consecutive patients.
作者信息
Noori Ibrahim Falih
机构信息
Department of Surgery, College of Medicine, University of Basrah, Iraq.
出版信息
Ann Med Surg (Lond). 2021 May 19;66:102413. doi: 10.1016/j.amsu.2021.102413. eCollection 2021 Jun.
BACKGROUND
About 75%-85% of enterocutaneous fistulas are postoperative. Such fistulas are still disastrous and frustrating complication for surgeon and the patient and their management remains one of major challenge and dilemma in general surgical practice. Strict adherence to treatment guideline according to SOWATS protocol could results in better outcomes.
THE OBJECTIVE
of this study was to assess the management outcomes of 23 patients with postoperative enterocutaneous fistulas.
METHODS
A total of 23 consecutive patients with postoperative enterocutaneous fistulas during the period of study were included. These fistulas were classified anatomically and physiologically. The predictive factors for spontaneous closure, management outcomes and mortality rate factors for were studied.
RESULTS
Overall Closure of the fistulas was accomplished in 16 patients (69.6%). Spontaneous closure after successful conservative management was seen in 4 patients (17.4%). The average time between fistula development and spontaneous closure was 32 days (range12-66 days). Of 19 patients underwent corrective surgery, closure was achieved in 12 patients (52.2%), thus the surgical success rate was 63.2%. Surgical intervention was performed after an average period of 28 days (range 18-42 days) from diagnosis of the fistula. Five patients with high output (21.7%) died because of sepsis, severe malnutrition and organ failure.
CONCLUSION
adherence to standardized protocol and multidisciplinary approach of patients with enterocutaneous fistulas could results in good outcomes. A reasonable period of conservative treatment is always required to optimize patient's general conditions and for spontaneous closure of fistula. Operative correction is usually required for proximal high output and complex fistulas. The complexity of the fistulas, sepsis, high output effluent and comorbidities are the main factors affecting healing rates and fistula related mortality.
背景
约75%-85%的肠皮肤瘘是术后发生的。此类瘘对外科医生和患者而言仍是灾难性且令人沮丧的并发症，其处理仍是普通外科实践中的主要挑战和难题之一。严格遵循SOWATS方案的治疗指南可能会带来更好的结果。
本研究的目的
是评估23例术后肠皮肤瘘患者的治疗效果。
方法
纳入研究期间连续收治的23例术后肠皮肤瘘患者。这些瘘从解剖学和生理学角度进行分类。研究了瘘自发闭合的预测因素、治疗效果及死亡率因素。
结果
16例患者（69.6%）实现了瘘的总体闭合。4例患者（17.4%）在成功的保守治疗后实现了自发闭合。瘘形成至自发闭合的平均时间为32天（范围12-66天）。19例行矫正手术的患者中，12例（52.2%）实现了闭合，因此手术成功率为63.2%。手术干预在瘘诊断后平均28天（范围18-42天）进行。5例高流量瘘患者（21.7%）因败血症、严重营养不良和器官衰竭死亡。
结论
遵循标准化方案并采用多学科方法处理肠皮肤瘘患者可取得良好效果。总是需要一段合理的保守治疗时间来优化患者的一般状况并促进瘘的自发闭合。近端高流量瘘和复杂瘘通常需要手术矫正。瘘的复杂性、败血症、高流量流出物和合并症是影响愈合率和与瘘相关死亡率的主要因素。
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