摘要
目的:总结肠瘘不同阶段的治疗经验及分期手术策略在肠瘘确定性手术治疗中的应用.方法:采用回顾性病例数据,收集2016年1月-2019年12月清华大学附属北京清华长庚医院收治的255例肠瘘患者的临床资料,包括患者年龄、性别、原发疾病、致瘘原因、瘘的部位、瘘的数量、瘘的性质、瘘发生到就诊时间、肠瘘诊断评估方式、营养风险、营养支持方式、入院感染状态等进行初步总结.根据肠瘘病理生理特点进行肠瘘阶段治疗:肠瘘急性阶段-肠瘘稳定阶段-肠瘘确定性手术阶段.肠瘘确定性手术分期治疗:Ⅰ期手术和分期手术.并分析各个阶段治疗策略和治疗效果.结果:肠瘘急性阶段(141例),局部感染患者与严重感染患者之间的腹腔脓肿处理方式有明显差异(P=0.023),损伤控制外科手术适合严重感染患者.141例均进入肠瘘稳定阶段,其中112例患者接受全过程治疗,28例放弃,1例死亡.112例完整治疗患者中,75例治愈(治愈率83.7％),37例保守无效进入肠瘘确定性手术阶段;联合114例外院保守无效肠瘘患者;共计151例进入肠瘘确定性手术阶段;其中134例行Ⅰ期手术,17例行分期手术.151例患者手术治疗的总体结局,138例治愈(治愈率为91.4％).结论:根据肠瘘患者的发生和病理生理,正确归入肠瘘急性阶段、肠瘘稳定阶段或肠瘘确定性手术阶段并进行相应的治疗至关重要.另外,合理的手术时机和分期手术策略也是手术治疗肠瘘的关键所在.
Abstract
Objective:To summarize the surgical management experience on intestinal fistula(IF)patients with phasedtherapy and staged operation.Methods:Retrospectively analyzing the clin-ical data of 255 IF patientsin Beijing Tsinghua Changgung Hospital from January 2016 to December 2019,including age,gender,primary disease,IF causes,IF locations,IF numbers,IF natures,IF times,IF diagnoses and evaluations,nutritional risks,nutritional support,and infection statuses.Ac-cording to the pathophysiological characteristics of IF patients,IF therapy included three phases:Phase Ⅰ(IF acute onset),Phase Ⅱ(IF stable maintenance),Phase Ⅲ(IF deterministic operation).The IF deterministic operation included one-stage operation and multi-stage operation.The relationship between strategies and effects were analyzed in each treatment stage.Results:All 141 patients in Phase Ⅰ entered into Phase Ⅱ,in which 112 cases received complete treatment,28 cases gave up,and 1 case died.In 112 caseswho received complete treatment,75 cases were cured(83.7％),37 cases remained infected.The 37 cases that remained infected were combined with the 114 cases who were primarily hospitalized at Phase Ⅲ,were classified into 151 cases who received IF deter-ministic operations,in which 134 cases received stage Ⅰ surgery,and 17 cases received multi-stage surgery.138 cases were cured(91.4％).Conclusion:Intestinal fistula patients could exhibit a better cure ratio throughphasestherapy,which include the acute onset phase,stable maintenance phase,and deterministic operation phase.It is important to classify IF patients into the correct phase and conduct the corresponding treatment.The staged operations are also the key to the intestinal fistula-surgical strategy.
维普
万方数据