Pepe Gilda, Chiarello Maria Michela, Bianchi Valentina, Fico Valeria, Altieri Gaia, Tedesco Silvia, Tropeano Giuseppe, Molica Perla, Di Grezia Marta, Brisinda Giuseppe
Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy.
General Surgery Operative Unit, Department of Surgery, Provincial Health Authority, 87100 Cosenza, Italy.
J Clin Med. 2024 Feb 23;13(5):1279. doi: 10.3390/jcm13051279.
Enteric fistulas are a common problem in gastrointestinal tract surgery and remain associated with significant mortality rates, due to complications such as sepsis, malnutrition, and electrolyte imbalance. The increasingly widespread use of open abdomen techniques for the initial treatment of abdominal sepsis and trauma has led to the observation of so-called entero-atmospheric fistulas. Because of their clinical complexity, the proper management of enteric fistula requires a multidisciplinary team. The main goal of the treatment is the closure of enteric fistula, but also mortality reduction and improvement of patients' quality of life are fundamental. Successful management of patients with enteric fistula requires the establishment of controlled drainage, management of sepsis, prevention of fluid and electrolyte depletion, protection of the skin, and provision of adequate nutrition. Many of these fistulas will heal spontaneously within 4 to 6 weeks of conservative management. If closure is not accomplished after this time point, surgery is indicated. Despite advances in perioperative care and nutritional support, the mortality remains in the range of 15 to 30%. In more recent years, the use of negative pressure wound therapy for the resolution of enteric fistulas improved the outcomes, so patients can be successfully treated with a non-operative approach. In this review, our intent is to highlight the most important aspects of negative pressure wound therapy in the treatment of patients with enterocutaneous or entero-atmospheric fistulas.
肠瘘是胃肠道手术中的常见问题，由于脓毒症、营养不良和电解质失衡等并发症，其死亡率仍然很高。用于腹部脓毒症和创伤初始治疗的开放腹腔技术的日益广泛应用导致了所谓的肠-大气瘘的出现。由于其临床复杂性，肠瘘的恰当管理需要多学科团队。治疗的主要目标是闭合肠瘘，但降低死亡率和改善患者生活质量也至关重要。成功管理肠瘘患者需要建立可控引流、控制脓毒症、预防液体和电解质耗竭、保护皮肤以及提供充足营养。许多此类瘘管在保守治疗4至6周内会自行愈合。如果在此时间点后仍未闭合，则需进行手术。尽管围手术期护理和营养支持取得了进展，但死亡率仍在15%至30%之间。近年来，使用负压伤口疗法治疗肠瘘改善了治疗效果，因此患者可以通过非手术方法成功治疗。在本综述中，我们旨在强调负压伤口疗法在治疗肠皮肤瘘或肠-大气瘘患者中的最重要方面。
