中国实用外科杂志2025，Vol.45Issue(3)：270-273,4.DOI:10.19538/j.cjps.issn1005-2208.2025.03.06
肠瘘诊治若干焦点问题
Several focus issues and countermeasures in the diagnosis and treatment of intestinal fistula
摘要
Abstract
Enterocutaneous fistula is a common complication following gastrointestinal surgery,with a high mortality rate.Its occurrence typically results from the leakage of digestive fluids,leading to intra-abdominal infections,sepsis,multiple organ failure,and other severe complications.The pathophysiological characteristics of enterocutaneous fistula are closely related to its treatment.Based on different pathophysiological changes,enterocutaneous fistula can be classified into critical and stable types.Critical enterocutaneous fistulas typically occur in the early stages of the disease and have a higher mortality rate,while stable enterocutaneous fistulas refer to those in which the condition has been initially controlled,primarily facing issues such as fluid loss.The occurrence of enterocutaneous fistula can also trigger a series of complications,including increased intra-abdominal pressure,pulmonary infections,and renal failure.Early detection is crucial for the diagnosis of enterocutaneous fistula.Direct signs,such as the leakage of digestive fluids and changes in symptoms of intra-abdominal infection,as well as indirect signs like digestive enzyme corrosion,can all serve as diagnostic criteria.The timeliness of diagnosis plays a decisive role in formulating an effective treatment plan,which can significantly reduce the mortality rate.With the continuous advancement of endoscopic technology,treatment methods for enterocutaneous fistula have become more diverse.New techniques,such as endoscopic negative pressure therapy and mucosal debridement,provide more possibilities for the self-healing of the fistula.In terms of treatment,the management of enterocutaneous fistulas requires a staged approach.In the critical phase,the primary goal should be lifesaving,utilizing comprehensive measures such as fluid management,anti-infection therapy,and infection source control.As the condition stabilizes,the focus of treatment shifts to promote self-healing,reduce the need for surgical intervention,and provide nutritional support and pre-rehabilitation therapy.Although staged treatment strategies have shown preliminary success in practice,the treatment of enterocutaneous fistulas still faces many challenges,particularly in terms of personalized treatment and long-term management.Future research should further explore the pathophysiological characteristics of enterocutaneous fistulas and optimize treatment plans to achieve higher cure rates and better patient outcomes.关键词
肠瘘/腹腔感染/内镜治疗/预康复/病理生理/并发症/诊治策略Key words
enterocutaneous fistula/abdominal infection/endoscopic treatment/prehabilitation/pathophysiology/complications/diagnosis and treatment strategy分类
医药卫生引用本文复制引用
王革非,吴磊,任建安..肠瘘诊治若干焦点问题[J].中国实用外科杂志,2025,45(3):270-273,4.基金项目
国家自然科学基金面上项目(No.82170581) （No.82170581）
中国人民解放军东部战区总医院院管课题项目(No.2023JSYXMS152) National Natural Science Foundation of China(General Program,No.82170581) （No.2023JSYXMS152）
Hospital Management Project of General Hospital of Eastern Theater Command of the People's Liberation Army(No.2023JSYXMS152) （No.2023JSYXMS152）
