胃肠手术后肠瘘治疗时机及方式的选择效果分析
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摘要
目的分析胃肠手术后治疗肠瘘的时机和方式选择的效果。方法以我院2010年6月～2017年2月收治的行胃肠手术出现肠瘘的46例患者作为分析对象,并分成两组(实验组和对照组)进行比较,实验组23例为结直肠瘘患者,对照组23例为小肠瘘患者,分析两组患者选择治疗方式和时机的效果。结果对照组患者中,21例进行肠切除肠吻合手术,2例进行双腔造瘘手术,所有患者均得以治愈;实验组20例给予保守治疗,3例先进行早期控制,5个月后进行确定性手术,所有患者均得以治愈;两组患者治愈率均为100.0%,差异无统计学意义(P>0.05)。实验组患者的术后并发症发生率显著高于对照组(P<0.05),但两组患者的肠瘘复发率比较,差异无统计学意义(P>0.05)。结论对于小肠瘘患者,实施早期肠切除肠吻合手术,治疗效果显著,安全性高;对结直肠瘘患者,先进行保守治疗,并给予腹腔引流,治愈率比较高。
Objective To analyze the effect of timing and mode selection of intestinal fistula after gastrointestinal surgery. Methods A total of 46 patients with intestinal fistula who underwent gastrointestinal surgery in our hospital from June 2010 to February 2017 were included in the study and divided into two groups(experimental group and control group). 23 patients in the experimental group were patients with colorectal fistula. 23 patients in the control group were patients with small bowel fistula. The effects of treatment mode and timing in two groups were analyzed. Results Of the patients in the control group, 21 cases underwent intestinal resection and anastomosis, and 2 cases underwent double-cavity ostomy. All patients were cured. In the experimental group, 20 patients received conservative treatment,and 3 patients underwent early control and cured by definitive surgery after 5 months. All patients were cured. The data showed that the cure rate was 100.0% in both groups, the difference was not statistically significant(P>0.05). The postoperative complication rate in the experimental group was significantly higher than that in the control group(P<0.05),but the recurrence rate of intestinal fistula in the two groups was not statistically significant(P>0.05). Conclusion Early intestinal resection and anastomosis performed for patients with small bowel fistula, with remarkable treatment effect,and higher safety. The patients with colorectal fistula undergo conservative treatment first, and then are treated with abdominal drainage, and the cure rate is relatively higher.
Objective To analyze the effect of timing and mode selection of intestinal fistula after gastrointestinal surgery. Methods A total of 46 patients with intestinal fistula who underwent gastrointestinal surgery in our hospital from June 2010 to February 2017 were included in the study and divided into two groups(experimental group and control group). 23 patients in the experimental group were patients with colorectal fistula. 23 patients in the control group were patients with small bowel fistula. The effects of treatment mode and timing in two groups were analyzed. Results Of the patients in the control group, 21 cases underwent intestinal resection and anastomosis, and 2 cases underwent double-cavity ostomy. All patients were cured. In the experimental group, 20 patients received conservative treatment,and 3 patients underwent early control and cured by definitive surgery after 5 months. All patients were cured. The data showed that the cure rate was 100.0% in both groups, the difference was not statistically significant(P>0.05). The postoperative complication rate in the experimental group was significantly higher than that in the control group(P<0.05),but the recurrence rate of intestinal fistula in the two groups was not statistically significant(P>0.05). Conclusion Early intestinal resection and anastomosis performed for patients with small bowel fistula, with remarkable treatment effect,and higher safety. The patients with colorectal fistula undergo conservative treatment first, and then are treated with abdominal drainage, and the cure rate is relatively higher.
引文
[1]李伟,李志霞.胃肠手术后肠瘘治疗时机及方式的选择[J].临床和实验医学杂志,2013,12(24):1971-1974.
[2]张凯,刘学胜. 39例胃肠手术后肠外瘘的临床特点分析[J].临床医药文献电子杂志,2017,4(5):873.
[3]刘传渊,叶荣强,陈子文,等. PCT联合腹腔引流液淀粉酶检测在肠瘘早期诊断和预后评估中的临床应用[J].检验医学与临床,2017,14(22):3415-3417.
[4]吴健瑜,卢蔚起,潘远元,等.胃十二指肠溃疡急性穿孔患者腹腔镜下修补术后联合三联疗法治疗的临床疗效[J].现代消化及介入诊疗,2016,21(4):607-609.
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[6]吴科仕.经窦道α-氰基丙烯酸正丁酯改良胶封堵术在肠瘘患者中的临床效果及对胃肠功能的影响研究[J].吉林医学,2018,(3):13-14.
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[8]曹艳,马颖丽. 1例胃大部切除毕Ⅱ式吻合术后不完全性肠梗阻伴复杂肠瘘患者的护理体会[J].中西医结合护理(中英文),2016,2(2):132-133.
[9]银东智,袁又能,左燕妮,等.胃肠术后耐甲氧西林金黄色葡萄球菌肠炎21例临床分析[J].中国普外基础与临床杂志,2016,(3):328-332.
[10]杭铁虎.胃肠瘘患者普外手术后行肠外营养的临床效果观察[J].内蒙古医学杂志,2016,48(6):723-725.
[11]罗忠.对接受腹部手术后并发肠瘘的患者进行肠瘘手术的效果观察[J].当代医药论丛,2016,14(13):83-84.
[12]孙岩,连素娜.护理干预在重症急性胰腺炎患者术后并发症治疗中的应用价值[J].现代中西医结合杂志,2014,23(1):94-95.
[13]何晓生,郑晓彬,练磊,等.合并自发性腹腔脓肿的克罗恩病患者需早期手术的影响因素分析[J].中华胃肠外科杂志,2016,19(12):1379-1383.
[14]杨硕,陈杰,曹金鑫,等.主动减容手术防治肥胖患者巨大腹壁疝修补术后腹腔内高压的应用价值[J].中华消化外科杂志,2016,15(10):957-960.
[15]胡宝英,周海华,袁帅.内镜黏膜下剥离与腹腔镜下切除结直肠巨大宽蒂/广基息肉的临床观察[J].中国内镜杂志,2017,23(3):9-13.
[2]张凯,刘学胜. 39例胃肠手术后肠外瘘的临床特点分析[J].临床医药文献电子杂志,2017,4(5):873.
[3]刘传渊,叶荣强,陈子文,等. PCT联合腹腔引流液淀粉酶检测在肠瘘早期诊断和预后评估中的临床应用[J].检验医学与临床,2017,14(22):3415-3417.
[4]吴健瑜,卢蔚起,潘远元,等.胃十二指肠溃疡急性穿孔患者腹腔镜下修补术后联合三联疗法治疗的临床疗效[J].现代消化及介入诊疗,2016,21(4):607-609.
[5]肖美萍,陈学洪,黎衍香.营养支持结合功能锻炼治疗术后肠瘘的疗效观察与护理[J].当代医学,2017,23(36):4-6.
[6]吴科仕.经窦道α-氰基丙烯酸正丁酯改良胶封堵术在肠瘘患者中的临床效果及对胃肠功能的影响研究[J].吉林医学,2018,(3):13-14.
[7]赵中伟.胃肠手术后肠瘘治疗时机及方式的选择[J].临床医药实践,2016,25(10):799-800.
[8]曹艳,马颖丽. 1例胃大部切除毕Ⅱ式吻合术后不完全性肠梗阻伴复杂肠瘘患者的护理体会[J].中西医结合护理(中英文),2016,2(2):132-133.
[9]银东智,袁又能,左燕妮,等.胃肠术后耐甲氧西林金黄色葡萄球菌肠炎21例临床分析[J].中国普外基础与临床杂志,2016,(3):328-332.
[10]杭铁虎.胃肠瘘患者普外手术后行肠外营养的临床效果观察[J].内蒙古医学杂志,2016,48(6):723-725.
[11]罗忠.对接受腹部手术后并发肠瘘的患者进行肠瘘手术的效果观察[J].当代医药论丛,2016,14(13):83-84.
[12]孙岩,连素娜.护理干预在重症急性胰腺炎患者术后并发症治疗中的应用价值[J].现代中西医结合杂志,2014,23(1):94-95.
[13]何晓生,郑晓彬,练磊,等.合并自发性腹腔脓肿的克罗恩病患者需早期手术的影响因素分析[J].中华胃肠外科杂志,2016,19(12):1379-1383.
[14]杨硕,陈杰,曹金鑫,等.主动减容手术防治肥胖患者巨大腹壁疝修补术后腹腔内高压的应用价值[J].中华消化外科杂志,2016,15(10):957-960.
[15]胡宝英,周海华,袁帅.内镜黏膜下剥离与腹腔镜下切除结直肠巨大宽蒂/广基息肉的临床观察[J].中国内镜杂志,2017,23(3):9-13.