Harrison B J, Glanges E, Sparkman R S
Ann Surg. 1977 Feb;185(2):210-3. doi: 10.1097/00000658-197702000-00013.
Gastro-cutaneous fistula following splenectomy, a rare but serious occurrence, may result in death or prolonged disability. Six previous cases have been reported in detail, while 8 others have been mentioned briefly. The current report reviews the literature and describes 4 additional instances of this complication. Two of the 4 patients died. Sever factors, acting singly or incombination, may predispose to the development of post-splenectomy gastrocutaneous fistulas. These include direct surgical trauma to the gastric wall, generalized arteriosclerotic disease, hematoma in the gastrosplenic omentum, and reflection of gastric muscle fibers into the gastrosplenic ligament. The usual site of rupture of stomach is along the greater curvature in the fundic portion. In circumstances in which splenectomy is associated with known or suspected compromise of the blood supply to this portion of the stomach, a method of enfolding the greater curvature is proposed to prevent the development of a gastro-cutaneous fistula. Awareness of the possibility of this uncommon but serious complication will aid in its early recognition and treatment.
脾切除术后胃皮肤瘘是一种罕见但严重的情况，可能导致死亡或长期残疾。此前已详细报道过6例病例，另有8例被简要提及。本报告回顾了相关文献，并描述了另外4例这种并发症的情况。4例患者中有2例死亡。单一或综合起作用的严重因素可能易导致脾切除术后胃皮肤瘘的发生。这些因素包括对胃壁的直接手术创伤、全身性动脉硬化疾病、胃脾网膜血肿以及胃肌纤维延伸至胃脾韧带。胃破裂的常见部位是胃底部的大弯处。在脾切除术与已知或疑似该部分胃血供受损相关的情况下，建议采用一种包裹大弯的方法以预防胃皮肤瘘的发生。认识到这种罕见但严重并发症的可能性将有助于其早期识别和治疗。
