Zera R T, Bubrick M P, Sternquist J C, Hitchcock C R
Dis Colon Rectum. 1983 Feb;26(2):109-12. doi: 10.1007/BF02562587.
Fifty patients with 68 enterocutaneous fistulas were retrospectively reviewed at Hennepin County Medical Center from 1967 to June 1981. Eleven of 28 patients, treated with total parenteral nutrition (TPN) as the initial therapy for their fistulas, had spontaneous closure of 22 of 44 fistulas (three gastroduodenal, 17 small-bowel, two colonic fistulas). There were 35 operative procedures resulting in the closure of 26 fistulas, ten of which had failed to close with TPN (two gastroduodenal, ten small-bowel, and fourteen colonic fistulas). Overall mortality was 22 per cent, with five postoperative deaths and four deaths of patients treated with TPN. Aggressive use of TPN has not obviated the need for surgical closure in the authors' experience, particularly low in the gastrointestinal tract. Management should include TPN for up to four weeks and surgery if there has been no improvement with conservative therapy.
1967年至1981年6月期间，明尼阿波利斯亨内平县医疗中心对50例患有68处肠皮肤瘘的患者进行了回顾性研究。28例患者接受了全胃肠外营养（TPN）作为瘘管的初始治疗，其中11例患者的44处瘘管中有22处自行闭合（3处胃十二指肠瘘、17处小肠瘘、2处结肠瘘）。进行了35次手术，使26处瘘管闭合，其中10处瘘管采用TPN未能闭合（2处胃十二指肠瘘、10处小肠瘘、14处结肠瘘）。总死亡率为22%，术后死亡5例，接受TPN治疗的患者死亡4例。根据作者的经验，积极使用TPN并不能消除手术闭合的必要性，尤其是在胃肠道低位的情况下。治疗应包括使用TPN长达四周，若保守治疗无改善则进行手术。
