重症急性胰腺炎合并消化道瘘16例

目的:探讨重症急性胰腺炎(severe acute pancreatitis,SAP)合并消化道瘘的危险因素、临床诊治经验,其目的提高SAP治愈率,降低消化道瘘的发生率及病死率.方法:对2006-01/2011-08我科收治的16例SAP合并消化道瘘的临床资料进行回顾性研究,分析其发生的高危因素、发生部位、时间及对机体的影响,并对其临床诊断和治疗进行总结.结果:本组16例中结肠瘘6例,占37.5%(6/16),十二指肠瘘5例,占31.25%(5/16),胃瘘3例,占18.75(3/16),十二指肠瘘+结肠瘘1例,占6.25(1/16),十二指肠瘘+小肠瘘1例,占6.25(1/16);消化道瘘发生的时间多在SAP术后3-9wk内,16例均有胰外侵犯(胰腺假性囊肿1例,假性囊肿合并感染出血4例,胰周脓肿5例,合并胰腺坏死2例,细菌合并真菌感染3例),16例均经引流管造影确诊;早期手术2例(<2wk),晚期手术14例(>2wk);术中均放置引流管(2-11不等)且术后行冲洗引流,放置时间均>2wk;15例术中预防性行胃空肠造瘘并早期恢复肠内营养.本组治愈14例,治愈率为87.5%(14/16),因十二指肠瘘合并腹腔大出血自行放弃治疗1例,因结肠瘘合并全身感染并多发脏器功能衰竭而死亡1例.结论:SAP合并消化道瘘与胰液腐蚀、感染、手术时机及方式、引流管数量、位置、放置时间、早期恢复肠内营养等相关;经引流管及窦道造影检查是诊断消化道瘘的一种简便可靠的方法;防治的重点在于有效选择手术方式如微创并建立充分有效的引流,同时早期建立肠内营养支持治疗并积极控制感染.

Alimentary tract fistula associated with severe acute pancreatitis:an analysis of 16 cases

AIM:To investigate the risk factors,diagnosis and treatment of alimentary tract fistulas after severe acute pancreatitis (SAP) to improve the cure rate of SAP and reduce the morbidity and mortality of alimentary tract fistula.METHODS:A retrospective study was made on 16 SAP cases complicated with alimentary tract fistula,which were treated at our hospital from January 2006 to August 2011,to analyze its risk factors,location,time,influence on the body,and clinical diagnosis and treatment.RESULTS:Colonic fistulas occurred in 37.5% (6/16) of patients,duodenal fistulas in 31.25% (5/16),gastric fistulas in 18.75% (3/16),duodenal fistula + colonic fistula in 6.25% (1/16),and duodenal fistula + intestinal fistula in 6.25% (1/16).Alimentary tract fistulas were mostly found 3-9 weeks postoperatively.All patients had peripancreatic infection and were diagnosed accurately by X-ray.Early surgery was performed in 2 cases (<2 wk) and late operation in 14 patients (>2 wk).Intraoperative placement of drainage tubes (2-11) and postoperative drainage for >2 wk were performed in all patients.Fifteen cases underwent intraoperative prophylactic gastrostomy/jejunostomy and early enteral nutrition.Fourteen cases were cured,and the cure rate was 87.5% (14/16).One patient developed duodenal fistula and abandoned therapy because of abdominal cavity hemorrhage,and one patient who developed colonic fistula died of serious systematic infection and multiple organ failure.CONCLUSION:Alimentary tract fistula after SAP is related to pancreatic juice corrosion,infection,operation timing and mode,and quantity,position,and placement time of drainage tubes.X-ray is a reliable and safe method for diagnosis of alimentary tract fistulas.