早期控制性手术理念对治疗复杂性肠外瘘的临床价值(附35例报告)

目的评估早期应用“控制性手术”（control surgery，CS）理念治疗复杂性肠外瘘的临床价值。方法依据早期CS和全程完全保守措施的不同治疗方法对35例肠外瘘病例资料分组研究，比较两组病人治疗后相关临床指标的差别。结果CS组第4周体重增加率、瘘口自愈率明显高于保守治疗组（84．2％与31．3％、89．5％与37．5％）；第4周肝功能损害率、瘘口平均愈合时间、平均住院时间、平均住院费用与后者比较亦下降显著（P〈0．01）；两组间消化道出血、肺部感染、败血症、切口疝、粘连性肠梗阻等近、远期并发症发生率和死亡率、再入院率差异无统计学意义（P〉0.05）。结论复杂性肠外瘘早期实施积极的CS策略是肠外瘘外科治疗观念的重要转变，有利于肠外瘘的快速康复。

The clinical evaluation of tracking complicated instestinal fistula through control surgery early:A report of 35 cases

Objective To explore the clinical evaluation of the tracking complicated instestinal fistula through control surgery（CS） early. Methods The clinical index difference of two group data（35 cases） between the CS early and completely conservative treatment during the whole range were contrasted. Results The rate of body weight gain at the fourth week and orificium fistulae spontaneous cure of the CS groups were higher obviously than the conservative groups（84. 2 % vs 31.3 %,89. 5 % vs 37. 5 %）. The liver functional lesion rate at the fourth week and the average time of orificium fistulae heal or hospitalization and the cost of hospitalization were all less significantly than the latter（P〈 0. 01 ）;The difference of complication rate（ recent or long-time）include hemorrhage, pulmonary infection,septicaemia, incisional hernia, adhensive small-bowel obstruction and death rate or readmission rate between the two groups were no significant（P〉0. 05）. Conclusion Enforcing active strategy of CS to treat the complicated instestinal fistula early were important presentational change, It can be the fast tracking to cure the instestinal fistula.