肠外瘘34例治疗分析

目的：对肠外瘘的发生、发展、治疗方法及疗效进行研究，探讨其合理的诊断和治疗方法。方法：分析34例肠外瘘发生的原因、诊断、临床表现，所有病人均行禁食，胃肠减压，维持水、电解质平衡，抗感染、通畅引流等一般治疗，部分病人行全胃肠外营养(TPN)及应用生长抑素等非手术治疗。结果：高位肠癌13例，6例早期手术2例治愈，7例保守治疗6例治愈，低位肠癌21例，其中5例手术4例治愈，另16例保守治疗13例成功。结论：肠外瘘大多宜保守治疗，经过正规的非手术治疗效果不佳时，可以考虑手术治疗，有弥漫性腹膜炎者，及时行冲洗，引流及粪便转流可降低死亡率，必要时配合TPN和生长抑素等。

Analysis of diagnosis and treatment of 34 patients with intestinal fistulas.Huang Hai,Department of General surgery

Objective To analyse the possible causes,clinical development,treatment of fistulas,and to investigate the methods of diagnosis and treatment.Methods possible causes,diagnosis and clinical manifestations were analysed retrospectively in 34 cases of intestinal fistulas from December 1992 to June 2002.All patients received medical therapy,such as fast,gastrointestinal decompression,anti-infection.etc.At the same time,partial cases received total parenteral nutrition (TPN) and somatostatin.Results Among all patients,2 of 6 cases treated with early repair of operation and 6 of 7 cases with conservative methods were cured in 13 cases of high intestinal fistulas,4 of 5 conservative treatment were cured in 21 cases of low intedtinal fistuals.Conclusion Conservation treatment is necessary for all patients with intestinal fistulas before curible operation is considered.Operation may be considered if the conservation treatment do not get good effect.Douche,drainage and fecal diversion in time can lower the mortality of those with diffuse peritonitis.The fistula closing spontaneously and successful operation depend on using TPN combined with somatostatin.