上消化道隧道内镜术后消化道瘘的评估与处理

为探讨上消化道隧道内镜术后消化道瘘的评估和处理方法，回顾性分析2012年1月—2022年10月于复旦大学附属中山医院内镜中心诊疗的15例上消化道隧道内镜术后发生消化道瘘患者的临床资料。患者经综合治疗后消化道瘘均成功愈合。3例患者采用了金属夹夹闭瘘口并留置胃管；10例患者采用了胃管联合小肠营养管置入术，其中7例胃管直接置入瘘腔中引流；2例患者接受了食管覆膜支架联合小肠营养管置入术。5例患者接受过创面组织胶喷洒；2例患者在瘘口缩小后，接受了热活检钳或氩离子凝固术灼烧瘘口，行尼龙绳+金属夹荷包缝合。由此可见，隧道内镜术后消化道瘘是复杂的术后并发症，需要早期发现、仔细评估和综合处理。

Evaluation and management of gastrointestinal fistula after upper gastrointestinal tunnel endoscopic surgery

To investigate the evaluation and management of gastrointestinal fistula after upper gastrointestinal tunnel endoscopic surgery, a retrospective analysis was performed on 15 patients with gastrointestinal fistula after upper gastrointestinal tunnel endoscopic surgery, who were treated at the Endoscopy Center of Zhongshan Hospital, Fudan University from January 2012 to October 2022. All patients were treated successfully after comprehensive treatment. Three patients received metal clipping and gastric tube drainage; 10 patients received gastric tube drainage combined with jejunal nutritional tube placement,and 7 of them had gastric tube directly put into the fistula cavity; 2 patients received covered esophageal stent placement combined with jejunal nutritional tube placement. Five patients received wound tissue glue spraying; 2 patients underwent purse-string suture with nylon loops and metal clips after reduced fistula burned by hot biopsy forcep or argon plasma coagulation. The gastrointestinal fistula after tunnel endoscopic surgery is a complex postoperative complication, which needs early detection, careful evaluation and comprehensive treatment.