Enterocutaneous fistula is one of the common serious diseases in abdominal surgery, which can cause systemic and local pathophysiological dysfunction and seriously affect the quality of life of patients. In recent years, although there has been a greater understanding of the pathophysiological changes in enterocutaneous fistulae, as well as improvements in treatment strategies and methods, the outcome of treatment has improved, but it is still very difficult to deal with in clinical work. A total of 18 cases of intestinal fistulas were treated in our hospital between 2000 and 2007, and all achieved good clinical results after comprehensive treatment.
Intestinal fiatula is a common and serious complication of abdominal surgery, which often leads to water, electrolyte and acid-base imbalance, severe infection and multi-organ failure due to nutritional disorders. The mortality rate ranges from 5.3% to 21.3%, especially for high intestinal fistula, which often causes more pain to the patient. The treatment measures include: ① Adequate drainage and infection control: poor drainage leading to the spread of infection is an important reason for the failure of enterocutaneous fistula treatment. Within 7 d after the occurrence of an enterocutaneous fistula, the intestinal contents flow out through the defect in the intestinal wall, causing severe irritation to the organs surrounding the abdomen and causing an inflammatory reaction in the abdomen. When an intestinal fistula is found, more fluid is usually trapped in the abdominal cavity, and the edema around the intestinal fistula is obvious and the infection is serious. The choice of antibiotics should be based on the results of bacterial culture and drug sensitivity tests, making the treatment targeted. Data show that the mortality rate associated with sepsis is as high as 63%, and the mortality rate of surgical interventions for patients with sepsis is 50%, so controlling sepsis becomes the key to a good prognosis [1] ② Nutritional support, including total parenteral nutrition (TPN) and enteral nutrition (EN): before the 1960s, the mortality rate of enterocutaneous fistula was as high as 40-50%, and deaths due to malnutrition accounted for about 48%. In the early stage of enterocutaneous fistula, for high level and high flow enterocutaneous fistula, TPN treatment should be the main treatment. Total intravenous nutrition can reduce the secretion of gastrointestinal fluid, reduce the leakage of intestinal fluid, and ensure the water-electrolyte balance and adequate replenishment of various nutritional elements required by the body, which is conducive to the reduction of fistula opening and even self-healing. However, TPN can be complicated by infection, sludge and liver function damage, so when the infection is controlled and the drainage is reduced, there should be a gradual transition to EN, while EN is good for protecting the barrier role of the intestinal mucosa, avoiding bacterial translocation and improving the nutritional status. Nutritional support is very important for patients with enterocutaneous fistula, and its not only can clinically shorten the treatment time, but also plays an important role in improving the cure rate of tubular fistula and ensuring the success of surgery. The rational use of growth inhibition and growth hormone: growth inhibition and its derivatives can inhibit the secretion of gastroenteropancreatic fluid. Giving growth inhibition or its derivatives on the basis of TPN can significantly reduce the volume of intestinal fistula, reduce the skin damage around the fistula, and play a positive role in promoting the treatment of extraintestinal fistula, especially high intestinal fistula. From 1992 to 1997, the Zhongshan Hospital of Fudan University applied TPN plus growth inhibition to treat nearly 80 cases of gastrointestinal fistula, and all of them obtained good results [2]. Growth hormone has the function of promoting protein synthesis and tissue growth and healing, improving systemic anabolism and promoting local granulation growth, etc. On the basis of nutritional support and application of growth inhibitors, the addition of growth hormone can promote the healing process of extraintestinal fistula. ④ Small intestinal fluid reinfusion: small intestinal fluid reinfusion is easy to operate and can save the treatment cost of patients with enterocutaneous fistula, which has an important role in the nutritional support treatment of small intestinal fistula patients. Small intestinal fluid contains a large amount of water, electrolytes and digestive enzymes. It can also effectively maintain the morphology and function of the distal intestinal canal and prevent atrophy of the intestinal canal, which makes it easy to separate and anastomose during reoperation. The surgical treatment: If the fistula does not heal on its own after a long period of conservative treatment, definitive surgical treatment should be performed after a delay of more than 3-6 months, when the abdominal infection is controlled and the nutritional status of the body is significantly improved, the surgical cure rate is high and the postoperative recurrence rate is low.
In conclusion, with the advancement of treatment technology, the early diagnosis rate of enterocutaneous fistula is increasing and the mortality rate is decreasing significantly, but the huge treatment cost also brings a huge economic burden to patients and their families. Therefore, while improving the level of treatment of enterocutaneous fistula, it is most important how to avoid and reduce the occurrence of enterocutaneous fistula. Adequate preoperative bowel preparation, improvement of nutritional status, correct surgical approach, good intraoperative anesthesia, adequate field exposure, strict aseptic operation, reasonable postoperative perioperative medication, and satisfactory drainage are all prerequisites for preventing the occurrence of enterocutaneous fistula.