Gefen R, Garoufalia Z, Zhou P, Watson K, Emile S H, Wexner S D
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Tech Coloproctol. 2022 Nov;26(11):863-874. doi: 10.1007/s10151-022-02656-3. Epub 2022 Aug 1.
Enterocutaneous fistula (ECF) is an abnormal communication between the gastrointestinal tract and skin, with a myriad of etiologies and therapeutic options. Management is influenced by etiology and specifics of the ECF, and patient-related factors. The aim of this study was to assess overall success, recurrence, and mortality rates of treatment for ECF.
A systematic search of PubMed and Google Scholar was performed through October 2021 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports, reviews, animal studies, studies not reporting outcomes, had no available English text, included patients < 16 years old or those assessing other abdominocutaneous/internal fistulas were excluded.
Fifty-three studies, between 1975 and 2020, incorporating 3078 patients were included. Patient age ranged between 16 and 87 years with a male:female ratio of 1.14:1. ECF developed postoperatively in 89.4%. Other common etiologies were inflammatory bowel disease, trauma, malignancy, and radiation. At least 28% of patients had complex fistulae (reported in 18 studies). Most common fistula site was small bowel. In 34 publications, 62.4% (n = 1371) patients received parenteral nutrition. In 45 publications, 72.5% underwent surgery to treat the fistula. Meta-analysis revealed an 89% healing rate; recurrence rate after initial successful treatment was 11.1%, and mortality rate was 8.5%. In a subgroup of patients who underwent combined ECF takedown and abdominal wall reconstructions (n = 315), 78% achieved fascial closure, mesh was used in 72%, hernia, and fistula recurrence rates were 19.7% and 7.6%, respectively.
Treatment of ECF must be individualized according to specific etiology and location of the fistula and the patient's associated conditions.
肠皮肤瘘（ECF）是胃肠道与皮肤之间的异常通道，病因和治疗选择众多。治疗受ECF的病因、具体情况以及患者相关因素影响。本研究的目的是评估ECF治疗的总体成功率、复发率和死亡率。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，截至2021年10月对PubMed和谷歌学术进行了系统检索。排除病例报告、综述、动物研究、未报告结果的研究、没有可用英文文本的研究、纳入年龄小于16岁的患者或评估其他腹壁/内部瘘的研究。
纳入了1975年至2020年间的53项研究，共3078例患者。患者年龄在16至87岁之间，男女比例为1.14:1。89.4%的ECF在术后发生。其他常见病因包括炎症性肠病、创伤、恶性肿瘤和放疗。至少28%的患者有复杂瘘（18项研究中有报告）。最常见的瘘部位是小肠。在34篇出版物中，62.4%（n = 1371）的患者接受了肠外营养。在45篇出版物中，72.5%的患者接受了手术治疗瘘。Meta分析显示愈合率为89%；初始成功治疗后的复发率为11.1%，死亡率为8.5%。在接受ECF切除联合腹壁重建的患者亚组（n = 315）中，78%实现了筋膜闭合，72%使用了补片，疝和瘘复发率分别为19.7%和7.6%。
ECF的治疗必须根据瘘的具体病因、位置以及患者的相关情况进行个体化。
