Welch J P, Warshaw A L
Am J Surg. 1977 Jun;133(6):658-61. doi: 10.1016/0002-9610(77)90147-7.
Five cases of malignant duodenocolic fistula seen at the Massachusetts General Hospital in the past thirty years are reviewed. Rarely encountered, these lesions are characterized by diarrhea, weight loss, abdominal pain, anemia, and sometimes feculent vomiting. Barium enemas are more likely to demonstrate the fistula tract than upper gastrointestinal series. Nutritional deficiencies may be profound, and the use of preoperative hyperalimentation is encouraged. Operations that accomplish only bypass of the fistula are of minimal palliative value, and the fistula should be divided or resected if possible. When feasible, wide resection is the procedure of choice, and a fourteen year survival is reported after this operation.
本文回顾了过去三十年间在麻省总医院所见的五例恶性十二指肠结肠瘘病例。这些病变较为罕见，其特征为腹泻、体重减轻、腹痛、贫血，有时还伴有粪便样呕吐。与上消化道造影相比，钡剂灌肠更有可能显示瘘管。营养缺乏可能很严重，因此鼓励术前使用胃肠外营养。仅对瘘管进行旁路手术的姑息价值极小，如有可能应将瘘管分离或切除。可行时，广泛切除是首选手术方式，据报道该手术后有患者存活了十四年。
