术后肠外瘘的治疗选择——一项回顾性病例系列研究。
Therapeutic Options in Postoperative Enterocutaneous Fistula-A Retrospective Case Series.
机构信息
I.C.U. Clinic, Clinical County Emergency Hospital of Craiova, 1. Tabaci Street, 200642 Craiova, Romania.
Doctoral School, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Street, 200349 Craiova, Romania.
出版信息
Medicina (Kaunas). 2022 Jun 30;58(7):880. doi: 10.3390/medicina58070880.
OBJECTIVES
The aim of the study was to present the results obtained in our experiment regarding the management of postoperative enterocutaneous fistulas (PECF).
MATERIALS AND METHODS
We conducted a retrospective study on 64 PECF registered after 2030 abdominal surgeries (1525 digestive tract surgeries and 505 extra-digestive ones) over a period of 7 years (1st of January 2014-31th of December 2020) in the 1st and 2nd Surgery Clinics, Clinical County Emergency Hospital of Craiova, Romania. The group included 41 men (64.06%) and 23 women (35.34%), aged between 21-94 years. Of the cases, 71.85% occurred in elderly patients over 65 years old. Spontaneous fistulas in Crohn's disease, intestinal diverticulosis, or specific inflammatory bowel disease were excluded.
RESULTS
The overall incidence of 3.15% varied according to the surgery type: 6.22% after gastroduodenal surgery, 1.78% after enterectomies, 4.30% after colorectal surgery, 4.28% after bilio-digestive anastomoses, and 0.39% after extra-digestive surgery. We recorded a 70.31% fistula closure rate, 78.94% after exclusive conservative treatment and 57.61% after surgery; morbidity was 79.68%, mortality was 29.68%.
CONCLUSION
PECF management requires a multidisciplinary approach and is carried out according to an algorithm underlying well-established objectives and priorities. Conservative treatment including resuscitation, sepsis control, output control, skin protection, and nutritional support is the first line treatment; surgery is reserved for complications or permanent repair of fistulas that do not close under conservative treatment. The therapeutic strategy is adapted to topography, morphological characteristics and fistula output, age, general condition, and response to therapy.
目的
本研究旨在介绍我们在术后肠-皮肤瘘（PECF）管理方面的实验结果。
材料和方法
我们对 2030 例腹部手术后（1525 例消化道手术和 505 例非消化道手术）出现的 64 例 PECF 进行了回顾性研究，这些手术是在罗马尼亚克卢日-纳波卡 1 号和 2 号外科诊所进行的，时间跨度为 7 年（2014 年 1 月 1 日至 2020 年 12 月 31 日）。该组包括 41 名男性（64.06%）和 23 名女性（35.34%），年龄在 21-94 岁之间。71.85%的病例发生在 65 岁以上的老年患者中。排除了克罗恩病、肠憩室病或特定炎症性肠病的自发性瘘。
结果
总体发生率为 3.15%，具体取决于手术类型：胃十二指肠手术后为 6.22%，肠切除术为 1.78%，结直肠手术后为 4.30%，胆肠吻合术后为 4.28%，非消化道手术后为 0.39%。我们记录的瘘管闭合率为 70.31%，单纯保守治疗后为 78.94%，手术后为 57.61%；发病率为 79.68%，死亡率为 29.68%。
结论
PECF 的管理需要多学科方法，并根据既定目标和优先事项的算法进行。包括复苏、脓毒症控制、输出控制、皮肤保护和营养支持在内的保守治疗是一线治疗方法；手术保留用于并发症或在保守治疗下未闭合的瘘管的永久性修复。治疗策略适应于病变部位、形态特征和瘘管输出、年龄、一般情况以及对治疗的反应。
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