| Objective: To explore the safety and effectiveness of definitive surgery in the treatment of postoperative enterocutaneous fistula;according to the boundary of 2 months,the time from the occurrence of enterocutaneous fistula to the implementation of definitive surgery,divide into early definitive surgery(EDS)group and postponed definitive surgery(PDS)group,and analyze the clinical characteristics of the two groups.Methods: From July 2014 to July 2019,the clinical data of patients diagnosed enterocutaneous fistula by gastrointestinal surgery in Zunyi Medical University and treated by definitive surgery were analyzed retrospectively:(1)To evaluate the safety and effectiveness of definitive surgical treatment:(1)the occurrence of postoperative complications such as incisional hernia,(2)the mortality within 1 month,(3)the change of BMI in 3 months,(4)the recurrence of enterocutaneous fistula in 6 months;(2)The patients in EDS group and PDS group were compared:(1)the location and output of fistula,(2)preoperative treatment: antibiotics,somatostatin,nutritional support,(3)preoperative inflammatory indicators: T,P,WBC,N,CRP,(4)preoperative nutritional indicators: ALB,PAB,Hb,NRS 2002 score,(5)definite operation: surgical approach,Whether the incision is through the fistula,intraoperative time and bleeding volume of patients with small intestinal fistula,(6)postoperative complications,time from operation to discharge and BMI changes in three months after operation.Results: A total of 15 patients were included in this study.The definite operation time was 4 days to 84 months,and the median time was 7 months.(1)Safety and effectiveness of definitive surgical treatment results:(1)there were 6 postoperative complications in 15 patients,including 4 cases of incision infection,1 case of anastomotic bleeding,1 case of inflammatory intestinal obstruction,which were relieved by non-surgical treatment,no incisional hernia,(2)no death within 1 month,(3)BMI increased in 3 months after operation(P = 0.013),(4)no recurrence in 6 months after operation;(2)The patients in EDS group and PDS group were 5 and 10 respectively.The operation in the EDS group was 4-44 days after the occurrence of intestinal fistula.The causes of early definitive operation included:(1)the short bowel syndrome was obvious,(2)the tissue defect around the fistula was large and continued to expand,which was not conducive to nursing and affected the incision closure during the operation,(3)the patients could not tolerate the severe pain of the fistula for a long time,3-84 months after the occurrence of the external intestinal fistula in PDS group,and the median time was 12 months.In both groups:(1)The location and output of fistula: EDS group small intestinal fistula 100%;PDS group small intestinal fistula 40%,gastric fistula 30%,colorectal fistula 30%;The high,medium and low output fistulas in EDS group were 40%,40% and 20%,and the medium and low output fistulas in PDS group were 10% and 90%,(2)Preoperative antibiotics,somatostatin and nutritional support: 100%,80% and 100% in EDs group,50%,10% and 0% in PDS group,(3)preoperative inflammatory indexes: T and P were in the normal range in 3 days before operation in both groups,blood WBC,N and CRP were in the normal range or near the upper limit of normal value in 1-2 days before operation in both groups,(4)preoperative nutrition indexes: ALB,PAB,Hb and NRS 2002 scores before operation were(30.48 ± 2.19)g/L,(143.60 ± 40.26)mg/L,94.00(80.00 ~ 119.00)g/L and 5(4 ~ 5)in the EDS group,(37.09 ± 2.83)g/L,(199.20 ± 44.36)mg/L,124.00(87.00 ~ 178.00)g/L and 1(1 ~ 2)in the PDS group,(5)5(100%)in the EDS group underwent enterotomy and anastomosis and 3(60%)of surgical incision passing through the fistula,7(70%)in the PDS groupunderwent enterotomy and anastomosis,3(30%)underwent gastric wedge resection and repair,4(40%)of surgical incision passing through the fistula,both groups of patients underwent incision decompression and suture,(6)postoperative complications,time from operation to discharge and changes of BMI in three months after operation were80%,18(14-27)days,and increased BMI in three months after operation(P = 0.030)in EDS group;20%,9(7-28)days,and no significant increase in BMI in three months after operation(P = 0.157)in PDS group.Conclusion:(1)Definitive operation is an effective treatment for patients with ECF.The choice of operation time should be individualized according to the specific situation of patients;(2)After the occurrence of enterocutaneous fistula,as long as the patient’s condition permits,definitive surgery should be delayed.At that time,the patient is generally in better condition and the postoperative complications are low;(3)While the ECF patients have obvious symptoms of short bowel syndrome;the tissue defects around the fistulas are large and tend to continue to expand,which is not conducive to nursing and affects the incision closure during operation;when the patients can not tolerate the local severe pain of the fistulas for a long time,the early definitive operation should be carried out.The patients in the early definite operation group had a large amount of fistula,severe local inflammation,and poor nutritional status before the operation.They need to be treated with somatostatin,antibiotics and nutritional support,and the operation should be performed after the improvement as much as possible,which is of great significance for the success of the operation. |
