Urbanowicz K, Malinowski P
Oddzialu Chirurgii Ogólnej Szpitala Wojewódzkiego w Olsztynie.
Wiad Lek. 1997;50 Suppl 1 Pt 2:452-5.
In the years 1985-1996 82 patients with postoperative external fistulas of gastrointestinal tract (pefgt) were treated in the Department of General Surgery of Hospital in Olsztyn. The age of the patient varied from 18 to 70 years. 37 patients were women and 45 man. Volume of excreted fluid fluctuated from 100 ml to 3000 ml per day. The most frequent cause of pefgt was dehiscence of the anastomosis of jejunum in 31 patients, and operations of complications of gastric or duodenal ulcer disease in 30 patients. 54 patients underwent medical treatment. It was based on compensation of disorders in water and electrolyte balance and acid-base equilibrium, nutritional treatment, protection of the skin, suction of the excreted fluid, controlling of foci of infection, rehabilitation. 7 patients were reoperated for the purpose of closing the fistula and 21 to drain abscess or to stop bleeding. 57 (70%) out of 82 patients recovered, 25 (30%) died. In this number 14 patients among 54 treated conservatively and 11 out from 28 operated. The most frequent cause of death was sepsis (15 patients). The conservative treatment including TPN is successful in majority of patients with pefgt and indispensable in patients treated operatively. Special attention should be given for coexisting intraperitoneal abscessa, peritonitis and sepsis.
1985年至1996年期间，奥尔什丁医院普通外科治疗了82例胃肠道术后外瘘（pefgt）患者。患者年龄在18岁至70岁之间。女性患者37例，男性患者45例。每日排出液量在100毫升至3000毫升之间波动。pefgt最常见的原因是31例空肠吻合口裂开，30例胃或十二指肠溃疡疾病并发症手术。54例患者接受了内科治疗。治疗基于水和电解质平衡紊乱及酸碱平衡的补偿、营养治疗、皮肤保护、排出液抽吸、感染灶控制、康复。7例患者因闭合瘘管再次手术，21例因引流脓肿或止血再次手术。82例患者中有57例（70%）康复，25例（30%）死亡。其中，54例接受保守治疗的患者中有14例死亡，28例接受手术治疗的患者中有11例死亡。最常见的死亡原因是败血症（15例）。包括全胃肠外营养（TPN）在内的保守治疗对大多数pefgt患者是成功的，对接受手术治疗的患者是必不可少的。应特别关注并存的腹腔脓肿、腹膜炎和败血症。
