重症急性胰腺炎相关性消化道瘘14例临床分析
|
摘要
目的:探讨重症急性胰腺炎相关性消化道瘘的病因、临床诊治特点,其目的提高SAP治愈率,降低消化道瘘并发症的发生率及病死率。方法:对2000年1月-2008年10月我院收治的14例SAP并发消化道瘘的临床资料进行回顾性分析,分析其发生的病因、发生部位、时间及对机体影响,并对其临床诊断和治疗进行总结。结果:本组14例中结肠瘘5例,占35.71% (5/14),十二指肠瘘6例,占42.86% (6/14),小肠瘘2例,占14.29% ( 2/14),胃瘘1例,占7.14% (1/14);消化道瘘发生的时间多在SAP发病4-16周内,14例均有胰外侵犯,其中有8例形成胰周脓肿;14例均经引流管造影确诊。本组治愈9例,治愈率为64.2%(9/14),3例因经济问题自行放弃治疗,2例因严重全身感染和继发多脏器功能衰竭而死亡。结论:SAP并发消化道瘘与解剖因素、胰外炎症的侵犯程度、手术治疗的时机选择和方法等相关,其中胰外炎症的侵犯程度是其发生的最主要因素;经引流管和瘘道造影检查是诊断消化道瘘的一种简便可靠的方法;治疗的重点在于建立充分有效的引流,同时积极维持内环境的稳定,维护重要脏器功能,加强营养支持治疗,有效控制感染。预防以控制SAP的发展以及胰周感染的发生为中心环节。
Objective: To investigate the causes、diagnosis、measurement of the alimentary tract fistulas after severe acute pancreatitis(SAP), so as to increase its cure rate, decrease its case fatality rate. Methods: A retrospective study was made on 14 SAP cases compl- icated with alimentary tract fistulas to find out the risk factors, the location , the time and the effect to economy of complicated alimentary tract fistula, and to sum up the experien- ces of earlier diagnosis, comprehensive treatment. Results:Most patients occurred colo- nic fistulas 35.70 % (5/14) , duodenum fistulas 42.86% (6/14),small intestine fistulas 14.29% (2/14), stomach fistulas7.14%(1/14). Alimentary tract fistulas were found most in 4-16 weeks after SAP occurred, 14 cases all of them peripancreatic infection, 8 cases come in to been abscess. 14 cases were diagnosed by X- ray. nine cases recovered, the cure rate was 64.2%(9/14), three abandon the therapy and two died of serious systemtic infection and multiple organ systemtic failure. Conclusion:Alimentary tract fistulas complicated by SAP is related to anatomic factors, the degree of local inflameation and improper surgi- cal therapy, the most important is local inflameation . X- ray is a way of safty and credibility in diagnosis. The emphases of therapy is draingage in active, keep economy stabilization, protect vitals, strengthen nutriation suppor, control infects . The center of prevent tache is actively control SAP development and peripancreatic infection.
Objective: To investigate the causes、diagnosis、measurement of the alimentary tract fistulas after severe acute pancreatitis(SAP), so as to increase its cure rate, decrease its case fatality rate. Methods: A retrospective study was made on 14 SAP cases compl- icated with alimentary tract fistulas to find out the risk factors, the location , the time and the effect to economy of complicated alimentary tract fistula, and to sum up the experien- ces of earlier diagnosis, comprehensive treatment. Results:Most patients occurred colo- nic fistulas 35.70 % (5/14) , duodenum fistulas 42.86% (6/14),small intestine fistulas 14.29% (2/14), stomach fistulas7.14%(1/14). Alimentary tract fistulas were found most in 4-16 weeks after SAP occurred, 14 cases all of them peripancreatic infection, 8 cases come in to been abscess. 14 cases were diagnosed by X- ray. nine cases recovered, the cure rate was 64.2%(9/14), three abandon the therapy and two died of serious systemtic infection and multiple organ systemtic failure. Conclusion:Alimentary tract fistulas complicated by SAP is related to anatomic factors, the degree of local inflameation and improper surgi- cal therapy, the most important is local inflameation . X- ray is a way of safty and credibility in diagnosis. The emphases of therapy is draingage in active, keep economy stabilization, protect vitals, strengthen nutriation suppor, control infects . The center of prevent tache is actively control SAP development and peripancreatic infection.
引文
[1]张圣道,雷若庆.重症急性胰腺炎治疗的争论、进展和发展趋势[J].中国实用外科杂志,2002,22(1):22-23.
[2]孙家邦,朱斌,张键.暴发性胰腺炎诊治关键探讨[J].中国实用外科杂志,2003,23 (1) :53-55.
[3]吕云福主编.现代胰腺外科学[M].北京:人民军医出版社,2003,142-166.
[4]施益久,宋普春.急性重症胰腺炎术后并发症临床分析[J].现代实践医学杂志,2007,20(2):96-97.
[5]王平瑜,常华,姚立东等.重症急性胰腺炎的手术方法探讨[J].中华现代中西医杂志.2004,2(5):105-108.
[6]黎曙光,徐祥泽,梁永祥. 46例重症急性胰腺炎并发症的诊治分析[J].临床实践医药杂志2005,14(7):493-495.
[7] Brene T V,Edmondson H A.Colonic tistulization due to pancreatitis[J].Am J Surg.1996,11(1):359.
[8]陈登国,彭芹等.重症胰腺炎术后并发消化道瘘6例分析[J].河南大学学报(医学版),2006,25(2):45-47.
[9] Skaife P , Kingsnorth AN . Acute pancreatitis : assessment and management[J]. Posgard Med J ,1996 ,72(2): 277-283.
[10]中华医学会外科学会胰腺组.重症急性胰腺炎诊治指南[J].中华外科杂志, 2007, 45 (11) : 727-729.
[11]赵玉沛主编.胰腺病学[M].北京:人民卫生出版社,2007:331-333.
[12]黄志勇,杨东山.急性胰腺炎并发消化道瘘24例诊治[ J ].河南外科学杂志, 2001, 7(2):135-136.
[13] Wicky S,Gudinchet F,Barghouth G,et al. Three dimensional choangiospiral CT demonstration of a post-traumatic bile leak in a child[J].Eur Radiol,1999,9(1):99-102
[14] Suzuki A, Suzuki S,et al.Colonic fistula associated with severe acute pancreatitis: report of two cases.[J]Surg Today. 2008,38(2):178-83.
[15]涂发玖,冯林,何其琼等.重症急性胰腺炎(SAP)并发结肠瘘的诊治体会[J] .中国社区医师杂志, 2002,18( 21) : 20.
[16]黄侠,施俭,高卫陈,等.重症急性胰腺炎并发结肠瘘的探讨[J].中华普通外科杂志, 2000, 15(6): 719-721
[17]易彤波,卢崇亮.肠外瘘的诊断和进展[J].中国临床医学杂志,2003,10(2):271-273.
[18] Alvarez C ,Mcfadden DW,Reber HA. Complicated entericutaneous fitulas :failure of octreotide to improve healing[J]. World Surg ,2000 ,24(5) :533-537
[19] Yeo YS, Kim MH, et al. A case of pancreaticoportal fistula associated with acute severe pancreatitis[J]. Korean J Gastroenterol. 2005;46(6):485-488.
[20]杨治力,杨连粤.肠瘘的诊治近况[J].临床外科杂志.2001;9(5):321-322.
[21]张肇达主编.急性胰腺炎[M].北京:人民卫生出版社,2004:220-222.
[22] Kalayci C , Aisen A , Canal D , et al. Magnetic resonance cholangiopancr- eatography documents bile leak site after cholecystectomy in patients with aberrant right hepatic duct where ERCP fails[J]. Gastrointest Endosc , 2000 ,52 (2) :277-281.
[23]任建安,黎介寿.影像学检查在肠瘘诊治中的作用[J].中国实用外科杂志,1999,18(4):197-198.
[24]贾忠,罗中尧.急性胰腺炎术后并发结肠瘘诊断与治疗[J].医学研究杂志, 2007, 36(12) :94-95.
[25] Draus JM Jr, Huss SA,et al. Enterocutaneous fistula: are treatments improving? [J] Surgery. 2006 ,140(4):570-576.
[26]韩宗明,张学贞,李吉利等.肠外瘘的治疗体会[J].河南大学学报(医学版),2006,25(2):45-47.
[27]梁刚,陈刚,王彬.联合应用生长抑素和生长激素治疗重症胰腺炎和胰肠瘘[J].浙江医学杂志2002,24(1):38-39.
[28] Wang X , Wang B , Wu J , et al . Beneficial effects of groth hormone on bacterial translocation during the course of acute necrotizing pancreatitis in rats [J]. Pancreas ,2001, 23(2):148-156.
[29]龙跃平,王春友.重症急性胰腺炎术后胃肠道瘘的治疗[J].中国普通外科杂志2003,12(2):94-96
[30]林志强,王在国.肠外瘘的诊治现状与进展[J].岭南现代临床外科杂志.2007,7(6):467-468.
[31]黎介寿,任建安,王革非.肠外瘘早期确定性手术的可行性[J] .解放军医学, 2004, 29(5): 389- 391.
[32]任建安,黎介寿等.重视肠瘘的早期诊断与快速治疗[J].中华胃肠外科杂志2006,9 (4):279-280.
[33] Mohamed SR , Siriwardena A K.Understanding the colonic complications of pancreatitis[J].Pancreatology 2008,8(2): 153-158.
[34] Wainstein DE, Fernandez E,et al. Treatment of high-output enterocutaneous fistulas with a vacuum-compaction device. A ten-year experience[J].World J Surg.2008 Mar,32 (3): 430-435.
[35]严律南,刘续宝.重症急性胰腺炎手术并发症的防治[J].中华肝胆外科杂志2004,10(8):508.
[36] Calleja Subiran MC, Urien Blazquez LM. Colonic perforation, a rare complication of acute necrotizing pancreatitis[J]. AnMed Interna, 2006, 23(5) : 235-237.
[37]汪建平,王磊.肠外瘘的基础与临床[J].中国实用外科杂志,1999,(4):196-197.
[38] Gloor B,Uhl W,Muller CA,et al.The role of surgery in the management of acute pancreatitis[J].Can J Gastroenterol.2000,14 (Suppl D):136-140.
[39]江滨,井清源.重症急性胰腺炎并发消化道瘘的病因分析[J] .江苏医药杂志, 1999,25(2) :146.
[1] Slade D,Scote N. Intestinal fistulas [J]. Surgury (GBR) 2008,26(8): 343-346
[2]徐原月.小肠外瘘治疗体会[J] .华夏医学杂志, 2003,16( 1) : 99-100.
[3] Skaife P , Kingsnorth AN . Acute pancreatitis : assessment and management[J] . Posgard Med J ,1996 ,72( 2 ) : 277-283.
[4] Yeo YS, Kim MH, Yu MH, et al. A case of pancreaticoportal fistula associated with acute severe pancreatitis[J]. Korean J Gastroenterol. 2005 Dec,46(6):485-488.
[5]崔国平,周万祥,蔺建章.急性重症胰腺炎术后并发症临床分析[J].河北医学杂志,2002,8(5):408.
[6]姜洪池,刘昶.重症急性胰腺炎手术治疗的有关问题[J].中华肝胆外科杂志.2003,9(11):690-691.
[7]王春友.重症急性胰腺炎的综合治疗[J].临床外科杂志2005,13 (1):12-14.
[8]黄志勇,杨东山.急性胰腺炎并发消化道瘘24例诊治[J].河南外科学杂志, 2001, 7(2):135-136.
[9]胡伟明,张肇达,田伯乐等.重症急性胰腺炎术后并发肠瘘的原因和治疗[J].四川医学杂志2002,23(1):28-29
[10] AppelorsLS,Bugrstomr. A Short and long temr out come of severe acute Pancreatitis [J]. Eur J Surg,2001,16(7):281-286.
[11]舒志军,李维勤,王新波等.重症急性胰腺炎胃肠道并发症[J] .肝胆外科杂志, 1998,10(3) : 142-143.
[12] Brene TV,Edmondson HA.Colonic fistulization due to pancreatitis[J].Am J Surg.1996,11(1):359.
[13]赵玉沛主编.胰腺病学[M].第1版.北京:人民卫生出版社,2007:331-333.
[14]柴宗寿,郭欣,潘红梅等.重症胰腺炎并胰十二指肠瘘诊治分析(附8例)[J] .海南医学杂志,2007,18(4) :104-105
[15] Suzuki A, Suzuki S, Sakaguchi T,et al.Colonic fistula associated with severe acute pancreatitis: report of two cases[J]. Surg Today. 2008,38(2):178-183.
[16]黄侠,施俭,高卫陈等.重症急性胰腺炎并发结肠瘘的探讨[J].中华普通外科杂志, 2000,15: 719– 721.
[17]胡伟明,陆慧敏,张肇达等.重症急性胰腺炎术后并发肠瘘的诊断和治疗[J].临床外科杂志2007,15(10):664-665
[18]任建安,黎介寿.影像学检查在肠瘘诊治中的作用[J].中国实用外科杂志,1999,18(4):197-198.
[19]涂发玖,冯林,何其琼等.重症急性胰腺炎(SAP)并发结肠瘘的诊治体会[J] .中国社区医师杂志, 2002,18( 21) : 20.
[20]罗中尧,贾忠,封光华等.重症急性胰腺炎术后并发结肠瘘的原因分析与诊治对策[J].中华急诊医学杂志, 2003, 12 (5) :328-329.
[21] Mohamed SR,Siriwardena A K.Understanding the colonic complications of pancreatitis[J].Pancreatology 2008,8(2): 153-158
[22]李卫民.重症急性胰腺炎术后并发十二指肠瘘[J].中国普通外科杂志,2004, 13 (10):730-731
[23]龙跃平,王春友.重症急性胰腺炎术后胃肠道瘘的治疗[J].中国普通外科杂志2003,12(2):94-96
[24]任建安.重症急性胰腺炎并发肠外瘘的防治[J].肝胆外科杂志2001,9(3):163-164.
[25]杨植,王立平,刘东坡.重症急性胰腺炎并发十二指肠穿孔一例[J] .中华普通外科杂志, 2004,49(7) : 416.
[26]任建安,王革非,王新波,等.肠外瘘患者肠内营养支持临床应用研究[J].肠内与肠外营养,2000 ,7 (4) :204-208.
[27] Wang X , Wang B , Wu J , et al . Beneficial effects of groth hormone on bacterial translocation during the course of acute necrotizing pancreatitis in rats[J]. Pancreas , 2001,23(2):148-156.
[28]张肇达主编.急性胰腺炎[M].北京:人民卫生出版社,2004:220-222.
[29]马宏光,陈桂滋,贾振庚.重症急性胰腺炎并发症的防治[J].肝胆外科杂志,1999,7 (5):331-333.
[30] Kalayci C , Aisen A , Canal D , et al. Magnetic resonance cholangiopancreatogrphy documents bile leak site after cholecystectomy in patients with aberrant right hepatic duct where ERCP fails[J]. Gastrointest Endosc , 2000 ,52 (2) :277-281.
[31] Wicky S,Gudinchet F,Barghouth G,et al. Three dimensional choangiospiral CT demonstration of a post-traumatic bile leak in a child[J].Eur Radiol,1999,9(1):99-102
[32]严律南,刘续宝.重症急性胰腺炎手术并发症的防治[J].中华肝胆外科杂志2004,10(8):508.
[33]于鹏,刘继萍,蔡小博等.肠瘘外科治疗探讨[J] .中国冶金工业医学杂志, 2005, 22( 3) : 281.
[34] Szentkereszty Z, Kerekes L, Hallay J, et al. CT-guided percutaneous peripancreatic drainage: a possible therapy in acute necrotizing pancreatitis [J] Hepatogastroenterology, 2002, 49(48): 168-169.
[35] Jones SC ,Aron AT. Bleeding peptic ulcer endoscopic and pharmacological management [J].Postgard Med J ,1991 ,67(5): 606 -608 .
[36] Draus JM Jr, Huss SA,et al. Enterocutaneous fistula: are treatments improving? [J] Surgery. 2006 Oct;140(4):570-576;
[37] Alvarez C ,Mcfadden DW,Reber HA. Complicated entericutaneous fitulas :failure of octreotide to improve healing[J]. World J Surg ,2000 ,24(5) :533-537
[38] GloorB,UhiW,MullarCA,etal.The role of surgery in the managementAcute pancreatitis[J].CnaJGastroorl,2000,14( Suppl D):136-140.
[39] Banks PA. Acute pancreatitis :medical and surgical management [J] . Am J Gastroenterol ,1994 ,89 (suppl8) :78.
[40]任建安,黎介寿等.重视肠瘘的早期诊断与快速治疗[J].中华胃肠外科杂志2006,9 (4):279-280.
[2]孙家邦,朱斌,张键.暴发性胰腺炎诊治关键探讨[J].中国实用外科杂志,2003,23 (1) :53-55.
[3]吕云福主编.现代胰腺外科学[M].北京:人民军医出版社,2003,142-166.
[4]施益久,宋普春.急性重症胰腺炎术后并发症临床分析[J].现代实践医学杂志,2007,20(2):96-97.
[5]王平瑜,常华,姚立东等.重症急性胰腺炎的手术方法探讨[J].中华现代中西医杂志.2004,2(5):105-108.
[6]黎曙光,徐祥泽,梁永祥. 46例重症急性胰腺炎并发症的诊治分析[J].临床实践医药杂志2005,14(7):493-495.
[7] Brene T V,Edmondson H A.Colonic tistulization due to pancreatitis[J].Am J Surg.1996,11(1):359.
[8]陈登国,彭芹等.重症胰腺炎术后并发消化道瘘6例分析[J].河南大学学报(医学版),2006,25(2):45-47.
[9] Skaife P , Kingsnorth AN . Acute pancreatitis : assessment and management[J]. Posgard Med J ,1996 ,72(2): 277-283.
[10]中华医学会外科学会胰腺组.重症急性胰腺炎诊治指南[J].中华外科杂志, 2007, 45 (11) : 727-729.
[11]赵玉沛主编.胰腺病学[M].北京:人民卫生出版社,2007:331-333.
[12]黄志勇,杨东山.急性胰腺炎并发消化道瘘24例诊治[ J ].河南外科学杂志, 2001, 7(2):135-136.
[13] Wicky S,Gudinchet F,Barghouth G,et al. Three dimensional choangiospiral CT demonstration of a post-traumatic bile leak in a child[J].Eur Radiol,1999,9(1):99-102
[14] Suzuki A, Suzuki S,et al.Colonic fistula associated with severe acute pancreatitis: report of two cases.[J]Surg Today. 2008,38(2):178-83.
[15]涂发玖,冯林,何其琼等.重症急性胰腺炎(SAP)并发结肠瘘的诊治体会[J] .中国社区医师杂志, 2002,18( 21) : 20.
[16]黄侠,施俭,高卫陈,等.重症急性胰腺炎并发结肠瘘的探讨[J].中华普通外科杂志, 2000, 15(6): 719-721
[17]易彤波,卢崇亮.肠外瘘的诊断和进展[J].中国临床医学杂志,2003,10(2):271-273.
[18] Alvarez C ,Mcfadden DW,Reber HA. Complicated entericutaneous fitulas :failure of octreotide to improve healing[J]. World Surg ,2000 ,24(5) :533-537
[19] Yeo YS, Kim MH, et al. A case of pancreaticoportal fistula associated with acute severe pancreatitis[J]. Korean J Gastroenterol. 2005;46(6):485-488.
[20]杨治力,杨连粤.肠瘘的诊治近况[J].临床外科杂志.2001;9(5):321-322.
[21]张肇达主编.急性胰腺炎[M].北京:人民卫生出版社,2004:220-222.
[22] Kalayci C , Aisen A , Canal D , et al. Magnetic resonance cholangiopancr- eatography documents bile leak site after cholecystectomy in patients with aberrant right hepatic duct where ERCP fails[J]. Gastrointest Endosc , 2000 ,52 (2) :277-281.
[23]任建安,黎介寿.影像学检查在肠瘘诊治中的作用[J].中国实用外科杂志,1999,18(4):197-198.
[24]贾忠,罗中尧.急性胰腺炎术后并发结肠瘘诊断与治疗[J].医学研究杂志, 2007, 36(12) :94-95.
[25] Draus JM Jr, Huss SA,et al. Enterocutaneous fistula: are treatments improving? [J] Surgery. 2006 ,140(4):570-576.
[26]韩宗明,张学贞,李吉利等.肠外瘘的治疗体会[J].河南大学学报(医学版),2006,25(2):45-47.
[27]梁刚,陈刚,王彬.联合应用生长抑素和生长激素治疗重症胰腺炎和胰肠瘘[J].浙江医学杂志2002,24(1):38-39.
[28] Wang X , Wang B , Wu J , et al . Beneficial effects of groth hormone on bacterial translocation during the course of acute necrotizing pancreatitis in rats [J]. Pancreas ,2001, 23(2):148-156.
[29]龙跃平,王春友.重症急性胰腺炎术后胃肠道瘘的治疗[J].中国普通外科杂志2003,12(2):94-96
[30]林志强,王在国.肠外瘘的诊治现状与进展[J].岭南现代临床外科杂志.2007,7(6):467-468.
[31]黎介寿,任建安,王革非.肠外瘘早期确定性手术的可行性[J] .解放军医学, 2004, 29(5): 389- 391.
[32]任建安,黎介寿等.重视肠瘘的早期诊断与快速治疗[J].中华胃肠外科杂志2006,9 (4):279-280.
[33] Mohamed SR , Siriwardena A K.Understanding the colonic complications of pancreatitis[J].Pancreatology 2008,8(2): 153-158.
[34] Wainstein DE, Fernandez E,et al. Treatment of high-output enterocutaneous fistulas with a vacuum-compaction device. A ten-year experience[J].World J Surg.2008 Mar,32 (3): 430-435.
[35]严律南,刘续宝.重症急性胰腺炎手术并发症的防治[J].中华肝胆外科杂志2004,10(8):508.
[36] Calleja Subiran MC, Urien Blazquez LM. Colonic perforation, a rare complication of acute necrotizing pancreatitis[J]. AnMed Interna, 2006, 23(5) : 235-237.
[37]汪建平,王磊.肠外瘘的基础与临床[J].中国实用外科杂志,1999,(4):196-197.
[38] Gloor B,Uhl W,Muller CA,et al.The role of surgery in the management of acute pancreatitis[J].Can J Gastroenterol.2000,14 (Suppl D):136-140.
[39]江滨,井清源.重症急性胰腺炎并发消化道瘘的病因分析[J] .江苏医药杂志, 1999,25(2) :146.
[1] Slade D,Scote N. Intestinal fistulas [J]. Surgury (GBR) 2008,26(8): 343-346
[2]徐原月.小肠外瘘治疗体会[J] .华夏医学杂志, 2003,16( 1) : 99-100.
[3] Skaife P , Kingsnorth AN . Acute pancreatitis : assessment and management[J] . Posgard Med J ,1996 ,72( 2 ) : 277-283.
[4] Yeo YS, Kim MH, Yu MH, et al. A case of pancreaticoportal fistula associated with acute severe pancreatitis[J]. Korean J Gastroenterol. 2005 Dec,46(6):485-488.
[5]崔国平,周万祥,蔺建章.急性重症胰腺炎术后并发症临床分析[J].河北医学杂志,2002,8(5):408.
[6]姜洪池,刘昶.重症急性胰腺炎手术治疗的有关问题[J].中华肝胆外科杂志.2003,9(11):690-691.
[7]王春友.重症急性胰腺炎的综合治疗[J].临床外科杂志2005,13 (1):12-14.
[8]黄志勇,杨东山.急性胰腺炎并发消化道瘘24例诊治[J].河南外科学杂志, 2001, 7(2):135-136.
[9]胡伟明,张肇达,田伯乐等.重症急性胰腺炎术后并发肠瘘的原因和治疗[J].四川医学杂志2002,23(1):28-29
[10] AppelorsLS,Bugrstomr. A Short and long temr out come of severe acute Pancreatitis [J]. Eur J Surg,2001,16(7):281-286.
[11]舒志军,李维勤,王新波等.重症急性胰腺炎胃肠道并发症[J] .肝胆外科杂志, 1998,10(3) : 142-143.
[12] Brene TV,Edmondson HA.Colonic fistulization due to pancreatitis[J].Am J Surg.1996,11(1):359.
[13]赵玉沛主编.胰腺病学[M].第1版.北京:人民卫生出版社,2007:331-333.
[14]柴宗寿,郭欣,潘红梅等.重症胰腺炎并胰十二指肠瘘诊治分析(附8例)[J] .海南医学杂志,2007,18(4) :104-105
[15] Suzuki A, Suzuki S, Sakaguchi T,et al.Colonic fistula associated with severe acute pancreatitis: report of two cases[J]. Surg Today. 2008,38(2):178-183.
[16]黄侠,施俭,高卫陈等.重症急性胰腺炎并发结肠瘘的探讨[J].中华普通外科杂志, 2000,15: 719– 721.
[17]胡伟明,陆慧敏,张肇达等.重症急性胰腺炎术后并发肠瘘的诊断和治疗[J].临床外科杂志2007,15(10):664-665
[18]任建安,黎介寿.影像学检查在肠瘘诊治中的作用[J].中国实用外科杂志,1999,18(4):197-198.
[19]涂发玖,冯林,何其琼等.重症急性胰腺炎(SAP)并发结肠瘘的诊治体会[J] .中国社区医师杂志, 2002,18( 21) : 20.
[20]罗中尧,贾忠,封光华等.重症急性胰腺炎术后并发结肠瘘的原因分析与诊治对策[J].中华急诊医学杂志, 2003, 12 (5) :328-329.
[21] Mohamed SR,Siriwardena A K.Understanding the colonic complications of pancreatitis[J].Pancreatology 2008,8(2): 153-158
[22]李卫民.重症急性胰腺炎术后并发十二指肠瘘[J].中国普通外科杂志,2004, 13 (10):730-731
[23]龙跃平,王春友.重症急性胰腺炎术后胃肠道瘘的治疗[J].中国普通外科杂志2003,12(2):94-96
[24]任建安.重症急性胰腺炎并发肠外瘘的防治[J].肝胆外科杂志2001,9(3):163-164.
[25]杨植,王立平,刘东坡.重症急性胰腺炎并发十二指肠穿孔一例[J] .中华普通外科杂志, 2004,49(7) : 416.
[26]任建安,王革非,王新波,等.肠外瘘患者肠内营养支持临床应用研究[J].肠内与肠外营养,2000 ,7 (4) :204-208.
[27] Wang X , Wang B , Wu J , et al . Beneficial effects of groth hormone on bacterial translocation during the course of acute necrotizing pancreatitis in rats[J]. Pancreas , 2001,23(2):148-156.
[28]张肇达主编.急性胰腺炎[M].北京:人民卫生出版社,2004:220-222.
[29]马宏光,陈桂滋,贾振庚.重症急性胰腺炎并发症的防治[J].肝胆外科杂志,1999,7 (5):331-333.
[30] Kalayci C , Aisen A , Canal D , et al. Magnetic resonance cholangiopancreatogrphy documents bile leak site after cholecystectomy in patients with aberrant right hepatic duct where ERCP fails[J]. Gastrointest Endosc , 2000 ,52 (2) :277-281.
[31] Wicky S,Gudinchet F,Barghouth G,et al. Three dimensional choangiospiral CT demonstration of a post-traumatic bile leak in a child[J].Eur Radiol,1999,9(1):99-102
[32]严律南,刘续宝.重症急性胰腺炎手术并发症的防治[J].中华肝胆外科杂志2004,10(8):508.
[33]于鹏,刘继萍,蔡小博等.肠瘘外科治疗探讨[J] .中国冶金工业医学杂志, 2005, 22( 3) : 281.
[34] Szentkereszty Z, Kerekes L, Hallay J, et al. CT-guided percutaneous peripancreatic drainage: a possible therapy in acute necrotizing pancreatitis [J] Hepatogastroenterology, 2002, 49(48): 168-169.
[35] Jones SC ,Aron AT. Bleeding peptic ulcer endoscopic and pharmacological management [J].Postgard Med J ,1991 ,67(5): 606 -608 .
[36] Draus JM Jr, Huss SA,et al. Enterocutaneous fistula: are treatments improving? [J] Surgery. 2006 Oct;140(4):570-576;
[37] Alvarez C ,Mcfadden DW,Reber HA. Complicated entericutaneous fitulas :failure of octreotide to improve healing[J]. World J Surg ,2000 ,24(5) :533-537
[38] GloorB,UhiW,MullarCA,etal.The role of surgery in the managementAcute pancreatitis[J].CnaJGastroorl,2000,14( Suppl D):136-140.
[39] Banks PA. Acute pancreatitis :medical and surgical management [J] . Am J Gastroenterol ,1994 ,89 (suppl8) :78.
[40]任建安,黎介寿等.重视肠瘘的早期诊断与快速治疗[J].中华胃肠外科杂志2006,9 (4):279-280.