论文部分内容阅读
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.
Objective: To investigate the risk factors and clinical diagnosis and treatment of severe acute pancreatitis (SAP) complicated with gastrointestinal fistula, and to improve the cure rate of SAP and reduce the incidence and mortality of digestive tract fistula.Methods: / 2011-08 The clinical data of 16 SAP patients with gastrointestinal fistula admitted to our department were retrospectively analyzed. The high risk factors, the occurrence site, the time and the impact on the body were analyzed. The clinical diagnosis and treatment were summarized. Results: Sixteen cases of colonic fistula, accounting for 37.5% (6/16), five cases of duodenal fistula (31.25%), three gastric fistula (18.75%), , Duodenal fistula + colonic fistula in 1 case, accounting for 6.25 (1/16), duodenal fistula + intestinal fistula in 1 case, accounting for 6.25 (1/16); gastrointestinal fistula occurred more time after SAP In 3-9 weeks, 16 cases had extra-pancreatic invasion (1 case of pancreatic pseudocyst, 4 cases of pseudocyst with infection, 5 cases of peripancreatic abscess, 2 cases of pancreatic necrosis and 3 cases of fungal infection) Cases were diagnosed by drainage tube angiography; early surgery in 2 cases (<2wk), late surgery in 14 cases (> 2wk); drainage tubes were placed in operation (ranging from 2-11) and postoperative drainage and drainage, place> 2wk; 15 cases of intraoperative preventive sex Gastrojejunostomy and early recovery of enteral nutrition.This group of cured 14 cases, the cure rate was 87.5% (14/16), due to duodenal fistula combined intraperitoneal hemorrhage to give up treatment in 1 case, due to colon fistula with systemic infection and Multiple organ failure and death in 1 case.Conclusion: SAP with gastrointestinal fistula and pancreatic juice erosion, infection, timing and manner of operation, drainage tube number, location, placement time, early recovery of enteral nutrition and other related; by drainage tube and sinus Doppler imaging is a simple and reliable method for the diagnosis of gastrointestinal fistula. The focus of prevention and treatment is to select operative methods such as minimally invasive and establish adequate and effective drainage while establishing enteral nutrition supportive therapy and actively controlling infection.