Irving M
Br J Surg. 1977 Oct;64(10):690-4. doi: 10.1002/bjs.1800641003.
Intensive nutritional treatment is now recognized as the single most important factor in achieving closure of enterocutaneous fistulas, replacing attempts at early surgical closure. Operation in the early stages of management should be confined to the drainage of abscesses, the defunctioning of diseases or disrupted bowel and the formation of feeding enterostomies. In those few cases where spontaneous closure of the fistula does not occur, definitive surgical operation can be carried out when malnutrition has been corrected. The combination of nutritional treatment, skin protection and judicious surgery can reduce the mortality to below 10 per cent.
强化营养治疗现已被公认为实现肠皮肤瘘闭合的唯一最重要因素，取代了早期手术闭合的尝试。管理早期的手术应限于脓肿引流、病变或破裂肠管的去功能化以及喂养肠造口的形成。在少数瘘管未自发闭合的病例中，当营养不良得到纠正后可进行确定性手术。营养治疗、皮肤保护和明智的手术相结合可将死亡率降低至10%以下。
