肠瘘治疗（外文）课件.ppt

Enteric Fistulas: Principles of Management
historical perspective
Lillienthal (in 1901) and von Cackovic (6 years later) reported their experience with surgical management of ECF, with fatal es in all cases.
Even 20 years later, the reported overall mortality remained 81%.
historical perspective
The introduction of antibiotics in the mid-20th century did not improve mortality from ECF.
The major breakthrough came with the introduction of total parenteral nutrition (TPN)
Definitions
A fistula is an munication between two epithelialized surfaces
An ECF is an munication between the bowel lumen and skin.
Etiologic classification
Iatrogenic
Operation
Percutaneous drainage
Trauma
Foreign body
Crohn disease
Infectious disease
Tuberculosis
Actinomycosis
Malignancy
Physiologic classification
Low output <200ml/d
Moderate 200ml/d<x<500ml/d
High output >500ml/d
Current management of ECF
1. recognition and stabilization
2. anatomical definition and decision
3. definitive operation
Part1:recognition and stabilization
four lifethreatening focus of clinical attention
1. fluid and electrolyte imbalance
2. sepsis
3. nutrition
4. skin care
fluid and electrolyte imbalance
Hypokalemia is by far the mon electrolyte abnormality
Control of the effluent
Vacuum-assisted wound management
Somatostatin and octreotide
Intraabdominal infection
abscess ---drained percutaneously under CT guidance
Peritonitis---laparotomy to achieve source control