重症急性胰腺炎相关性消化道瘘的发生与预防探讨

目的：探讨重症急性胰腺炎（SAP）相关性消化道瘘的发生与预防。方法：回顾2000年1月—2012年1月收治的23例SAP并发消化道瘘患者的临床资料，分析SAP相关性消化道瘘的发生部位、发生时间，患者胰腺病变范围特点和并发消化道瘘与引流管置入情况。结果：全组23例患者中结肠瘘11例（47.8%），十二指肠瘘7例（30.4%），小肠瘘4例（17.4%），胃瘘1例（4.3%）；消化道瘘多发生在SAP术后1~2周内；患者腺病变累及范围大，常累及胰头、十二指肠、结肠等；16例患者的消化道瘘与引流管放置有关。结论：SAP并发消化道瘘不仅与解剖因素、胰外炎症侵犯、手术创伤等相关，而且与SAP自然病程相关，预防消化道瘘还需从SAP的整体治疗来考虑。

Alimentary tract fistula in severe acute pancreatitis: occurrence and prevention

Objective: To analyze the occurrence and preventive measure of alimentary tract fistula associated with severe acute pancreatitis (SAP).Methods: The clinical data of 23 SAP patients complicated with alimentary tract fistula admitted between Jan 2000 to Jan 2012 were reviewed. The location and time of onset of the digestive tract fistula, and extent and features of the pancreatic lesions of these patients as well as the relationship between the occurrence of digestive tract fistula and drainage tube placement were analyzed. Results: Of the entire group of 23 patients, 11 cases were colonic fistulas (47.8%), 7 cases were duodenal fistulas (30.4%), 4 cases were small bowel fistulas (17.4%), and 1 case was gastric fistula (4.3%). The alimentary tract fistulas generally occurred within the first or second week after operation for SAP. The extent of pancreatitis damage in these patients was relatively large, which usually affected the head of the pancreas, duodenum and colon. The occurrence of digestive tract fistula in 16 of these cases was associated with the drainage tube placement. Conclusion: Alimentary tract fistulas in SAP are related to anatomic factors, extra-pancreatic inflammation and surgical injury as well as the natural course of SAP. Prevention of alimentary tract fistulas should be integrated into the overall treatment of SAP.