术后肠外瘘的诊治体会

目的：探讨腹部手术后肠外瘘的病因、诊断及治疗方法。方法：回顾性分析20例肠外瘘的发生原因及诊治情况。结果：十二指肠残端瘘3例,小肠瘘6例,阑尾残端瘘2例,结肠瘘3例,直肠瘘5例,胃溃疡穿孔修补处瘘1例。主要原因有：①感染性吻合6例;②病理组织上吻合5例;③操作技术偏差4例;④炎性肠病、引流管压迫等5例。全组治愈17例,2例未愈等待手术,1例自动出院。结论：肠外瘘原因是多方面的,在维持内稳态和营养支持的前提下,建立有效的引流,应用生长抑素、生长激素,多数能自愈。

The discussion on the diagnosis and treatments of enterocutaneous fistula after abdominal surgeries

Obsjective:To investigate the etiology,diagnosis,and treatments of enterocutaneous fistula after abdominal surgeries.Methods:Retrospectively analyzed the causes and treatments of 20 enterocutaneous fistula cases from October,2008 to August,2010.Results:3 cases of duodenal stump fistula,6 cases of intestinal fistula,2 cases of appendiceal stump fistula,3 cases of colon fistula,5 cases of rectal fistula,and 1 case of gastric fistula after gastric ulcer perforation repair.Main reasons: ① 6 cases of infectious anastomosis;② 5 case of pathological anastomosis;③ 4 cases of technique deviation;④ 5 cases of inflammatory bowel disease and oppression of drainage tubes.17 cases were cured,2 cases are waiting for surgeries,1 patient was discharged with no treatment.Conclusion:There are many reasons causing enterocutaneous fistula.With an effective drainage and applicatioin of somatostatin and growth hormone,most cases can be self-healing.