4 例腸道內瘺患者行轉流治療的臨床分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

魯蒙 , 田茂霖 , 張鈴福 ,  修典榮

Corresponding?author：

修典榮, Email: xiudianrong@163.com

Keywords：

腸道內瘺; 轉流手術; 術后隨訪

DOI：

10.7507/1007-9424.201702011

Video：

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目的探討轉流手術在腸道內瘺治療中的應用價值。方法回顧性分析 2016 年在北京大學第三醫院行轉流手術治療的 4 例腸道內瘺患者的臨床資料。結果病例 1，直腸癌術后出現右側輸尿管瘺，先于膀胱鏡下行右側輸尿管支架置入術，術后癥狀短暫緩解，后肛門溢液再次出現，且逐漸發展為右腎積水, 3 個月后又行右側經皮腎造瘺術。病例 2，直腸癌術后出現尿道瘺，行腹腔鏡橫結腸雙腔造瘺術。病例 3，乙狀結腸憩室炎導致結腸膀胱瘺，行腹腔鏡探查、開腹膀胱后壁分離、膀胱瘺修補、結腸修補及末端回腸雙腔造瘺術。病例 4，盆腔腫瘤復發導致小腸陰道瘺，行腹腔鏡末端回腸雙腔造瘺術。4 例患者術后 1 周內原有癥狀消失，手術效果良好。術后隨訪 3 個月～1 年，病例 1 和病例 4 腫瘤原位復發；病例 2 于術后 6 個月行經肛門尿道修補手術成功；病例 3 于術后 6 個月時瘺口愈合，行造瘺口還納術。結論轉流手術治療腸道內瘺具有重要價值，但應嚴格把握適應證，并重視術后隨訪。

Citation： 魯蒙, 田茂霖, 張鈴福, 修典榮. 4 例腸道內瘺患者行轉流治療的臨床分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1125-1129. doi: 10.7507/1007-9424.201702011 Copy

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14.	Leicht W, Thomas C, Thüroff J, et al. Colovesical fistula caused by diverticulitis of the sigmoid colon: diagnosis and treatment. Urologe A, 2012, 51(7): 971-974.
15.	Aitken RJ, Elliot MS. Sigmoid exclusion: a new technique in the management of radiation-induced fistula. Br J Surg, 1985, 72(9): 731-732.
16.	陳綱, 杜峻峰, 李世擁, 等. 直腸癌術后直腸陰道瘺診治進展. 臨床軍醫雜志, 2012, 40(4): 978-980.
17.	Verriello V, Altomare M, Masiello G, et al. Treatment of post-prostatectomy rectourethral fistula with fibrin sealant (Quixil^TM) injection: a novel application. Tech Coloproctol, 2010, 14(4): 341-343.
18.	張國良, 徐向明, 林建江. 直腸陰道瘺的診治. 浙江中西醫結合雜志, 2013, 23(7): 555-557.
19.	李阿建, 薛利軍, 張亞杰, 等. 直腸陰道瘺的臨床治療策略. 外科理論與實踐, 2014, 19(6): 514-516.
20.	Gruner JS, Sehon JK, Johnson LW. Diagnosis and management of enterovesical fistulas in patients with Crohn’s disease. Am Surg, 2002, 68(8): 714-719.
21.	Kaimakliotis P, Simillis C, Harbord M, et al. A systematic review assessing medical treatment for rectovaginal and enterovesical fistulae in Crohn’s disease. J Clin Gastroenterol, 2016, 50(9): 714-721.
22.	荊翌峰, 夏術階, 孫宏斌, 等. 膀胱腸瘺診斷治療 12 例報告. 中華泌尿外科雜志, 2006, 27(10): 691-694.
23.	顧晉, 王林. 低位直腸癌術后直腸陰道瘺的診斷和治療. 中華外科雜志, 2006, 44(23): 1587-1591.

1. 李寧. 放射性腸炎的病程和外科治療. 中國實用外科雜志, 2004, 24(7): 9-13.
2. Hayne D, Vaizey CJ, Boulos PB. Anorectal injury following pelvic radiotherapy. Br J Surg, 2001, 88(8): 1037-1048.
3. 張東青, 徐祗順. 膀胱腸瘺. 現代泌尿外科雜志, 2004, 9(4): 247-248.
4. 孟慶成, 王芳麗, 吉小昌, 等. 直腸陰道瘺行轉流性腸造口術 15 例療效分析. 中國煤炭工業醫學雜志, 2013, 16(9): 1429-1430, 1431.
5. Zhang W, Zhu W, Li Y, et al. The respective role of medical and surgical therapy for enterovesical fistula in Crohn’s disease. J Clin Gastroenterol, 2014, 48(8): 708-711.
6. Andreani SM, Dang HH, Grondona P, et al. Rectovaginal fistula in Crohn’s disease. Dis Colon Rectum, 2007, 50(12): 2215-2222.
7. Gorcey S, Katzka I. Is operation always necessary for enterovesical fistulas in Crohn’s disease? J Clin Gastroenterol, 1989, 11(4): 396-398.
8. Cwikiel W, Andrén-Sandberg A. Malignant stricture with colovesical fistula: stent insertion in the colon. Radiology, 1993, 186(2): 563-564.
9. 唐承富, 潘長春, 王玉博, 等. 直腸支架在婦科腫瘤術后復發并梗阻中的應用. 中國介入影像與治療學, 2005, 2(1): 63-66.
10. Jessop J, Beagley C, Heald RJ. The pelican cancer foundation and the English National MDT-TME Development Programme. Colorectal Dis, 2006, 8 Suppl 3: 1-2.
11. Sharma A, Sharp DM, Walker LG, et al. Colorectal MDTs: the team’s perspective. Colorectal Dis, 2008, 10(1): 63-68.
12. Watanabe S, Honda I, Watanabe K, et al. Surgical procedures for digestive fistulae caused by radiation therapy. Surg Today, 2002, 32(9): 789-791.
13. 張連陽, 姚元章, 王韜, 等. 直腸癌術后直腸陰道瘺的治療策略. 重慶醫學, 2009, 38(5): 532-535.
14. Leicht W, Thomas C, Thüroff J, et al. Colovesical fistula caused by diverticulitis of the sigmoid colon: diagnosis and treatment. Urologe A, 2012, 51(7): 971-974.
15. Aitken RJ, Elliot MS. Sigmoid exclusion: a new technique in the management of radiation-induced fistula. Br J Surg, 1985, 72(9): 731-732.
16. 陳綱, 杜峻峰, 李世擁, 等. 直腸癌術后直腸陰道瘺診治進展. 臨床軍醫雜志, 2012, 40(4): 978-980.
17. Verriello V, Altomare M, Masiello G, et al. Treatment of post-prostatectomy rectourethral fistula with fibrin sealant (Quixil^TM) injection: a novel application. Tech Coloproctol, 2010, 14(4): 341-343.
18. 張國良, 徐向明, 林建江. 直腸陰道瘺的診治. 浙江中西醫結合雜志, 2013, 23(7): 555-557.
19. 李阿建, 薛利軍, 張亞杰, 等. 直腸陰道瘺的臨床治療策略. 外科理論與實踐, 2014, 19(6): 514-516.
20. Gruner JS, Sehon JK, Johnson LW. Diagnosis and management of enterovesical fistulas in patients with Crohn’s disease. Am Surg, 2002, 68(8): 714-719.
21. Kaimakliotis P, Simillis C, Harbord M, et al. A systematic review assessing medical treatment for rectovaginal and enterovesical fistulae in Crohn’s disease. J Clin Gastroenterol, 2016, 50(9): 714-721.
22. 荊翌峰, 夏術階, 孫宏斌, 等. 膀胱腸瘺診斷治療 12 例報告. 中華泌尿外科雜志, 2006, 27(10): 691-694.
23. 顧晉, 王林. 低位直腸癌術后直腸陰道瘺的診斷和治療. 中華外科雜志, 2006, 44(23): 1587-1591.

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4 例腸道內瘺患者行轉流治療的臨床分析

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