Degiuli M, Allone T, Pezzana A, Sommacale D, Gaglia P, Calvo F
Dipartimento Oncologico, Ospedale San Giovanni Antica Sede, Torino.
Minerva Chir. 1996 May;51(5):255-64.
The relations between incidence and prognosis of postoperative fistulas after gastrectomy and some different variables were analysed in the present retrospective study. Thirteen digestive fistulas of 113 patients (11.9%) submitted to gastrectomy during the period 1989-1994 represent the study population. The incidence of postoperative fistulas was compared to the kind of gastric pathology, to the extension of gastrectomy, to different nutritional (serum haemoglobin, albumin and transferrin level, weight loss) and immunological factors (serum lymphocytes) and, for oncological patients, to the stage of the disease. Incidence was directly related to the extension of gastrectomy, to serum albumin and haemoglobin level, and to weight loss rate. The results were not statistically significant at Kruskal-Wallis and ANOVA tests. No relation was found between incidence of fistulas and serum transferrin level, number of lymphocytes and adoption of early postoperative enteral nutrition. Six patients had spontaneous closure of the fistula with conservative therapy. Seven patients required reoperation because of abdominal sepsis (53.8%). Three patients died (23%). Although spontaneous closure, reoperation and mortality were related to nutritional and immunological state, no examined variables showed a statistically significative relation. The adoption of early postoperative enteral nutrition was not related to the prognosis, unlike the stage of the disease: patients submitted to reoperation had a TNM III or IV stage; dead patients had a TNM IV stage. Treatment of metabolic-nutritional unbalance can prevent anastomotic failure and fistula after gastrectomy and improve the prognosis. The relation between early postoperative enteral nutrition and incidence and prognosis of postoperative fistulas remains unclear.
在本回顾性研究中，分析了胃切除术后吻合口漏的发生率与预后以及一些不同变量之间的关系。1989年至1994年期间接受胃切除术的113例患者中有13例发生消化瘘（11.9%），这些患者构成了研究人群。将术后吻合口漏的发生率与胃部病变类型、胃切除范围、不同的营养因素（血清血红蛋白、白蛋白和转铁蛋白水平、体重减轻）和免疫因素（血清淋巴细胞）进行比较，对于肿瘤患者，还与疾病分期进行比较。发生率与胃切除范围、血清白蛋白和血红蛋白水平以及体重减轻率直接相关。在Kruskal-Wallis检验和方差分析中，结果无统计学意义。未发现吻合口漏发生率与血清转铁蛋白水平、淋巴细胞数量及术后早期肠内营养的应用之间存在关联。6例患者经保守治疗后吻合口漏自行闭合。7例患者因腹腔感染需要再次手术（53.8%）。3例患者死亡（23%）。尽管自行闭合、再次手术和死亡率与营养和免疫状态有关，但所检查的变量均未显示出统计学上的显著关系。与疾病分期不同，术后早期肠内营养的应用与预后无关：接受再次手术的患者为TNM III期或IV期；死亡患者为TNM IV期。代谢营养失衡的治疗可预防胃切除术后吻合口失败和吻合口漏，并改善预后。术后早期肠内营养与术后吻合口漏的发生率和预后之间的关系仍不明确。
