4 例肠道内瘘患者行转流治疗的临床分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

鲁蒙 , 田茂霖 , 张铃福 ,  修典荣

Corresponding author：

修典荣, Email: xiudianrong@163.com

Keywords：

肠道内瘘; 转流手术; 术后随访

DOI：

10.7507/1007-9424.201702011

Video：

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目的探讨转流手术在肠道内瘘治疗中的应用价值。方法回顾性分析 2016 年在北京大学第三医院行转流手术治疗的 4 例肠道内瘘患者的临床资料。结果病例 1，直肠癌术后出现右侧输尿管瘘，先于膀胱镜下行右侧输尿管支架置入术，术后症状短暂缓解，后肛门溢液再次出现，且逐渐发展为右肾积水, 3 个月后又行右侧经皮肾造瘘术。病例 2，直肠癌术后出现尿道瘘，行腹腔镜横结肠双腔造瘘术。病例 3，乙状结肠憩室炎导致结肠膀胱瘘，行腹腔镜探查、开腹膀胱后壁分离、膀胱瘘修补、结肠修补及末端回肠双腔造瘘术。病例 4，盆腔肿瘤复发导致小肠阴道瘘，行腹腔镜末端回肠双腔造瘘术。4 例患者术后 1 周内原有症状消失，手术效果良好。术后随访 3 个月～1 年，病例 1 和病例 4 肿瘤原位复发；病例 2 于术后 6 个月行经肛门尿道修补手术成功；病例 3 于术后 6 个月时瘘口愈合，行造瘘口还纳术。结论转流手术治疗肠道内瘘具有重要价值，但应严格把握适应证，并重视术后随访。

Citation： 鲁蒙, 田茂霖, 张铃福, 修典荣. 4 例肠道内瘘患者行转流治疗的临床分析. 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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3.	张东青, 徐祗顺. 膀胱肠瘘. 现代泌尿外科杂志, 2004, 9(4): 247-248.
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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.
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13.	张连阳, 姚元章, 王韬, 等. 直肠癌术后直肠阴道瘘的治疗策略. 重庆医学, 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.	陈纲, 杜峻峰, 李世拥, 等. 直肠癌术后直肠阴道瘘诊治进展. 临床军医杂志, 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.	张国良, 徐向明, 林建江. 直肠阴道瘘的诊治. 浙江中西医结合杂志, 2013, 23(7): 555-557.
19.	李阿建, 薛利军, 张亚杰, 等. 直肠阴道瘘的临床治疗策略. 外科理论与实践, 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.	荆翌峰, 夏术阶, 孙宏斌, 等. 膀胱肠瘘诊断治疗 12 例报告. 中华泌尿外科杂志, 2006, 27(10): 691-694.
23.	顾晋, 王林. 低位直肠癌术后直肠阴道瘘的诊断和治疗. 中华外科杂志, 2006, 44(23): 1587-1591.

1. 李宁. 放射性肠炎的病程和外科治疗. 中国实用外科杂志, 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. 张东青, 徐祗顺. 膀胱肠瘘. 现代泌尿外科杂志, 2004, 9(4): 247-248.
4. 孟庆成, 王芳丽, 吉小昌, 等. 直肠阴道瘘行转流性肠造口术 15 例疗效分析. 中国煤炭工业医学杂志, 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, 潘长春, 王玉博, 等. 直肠支架在妇科肿瘤术后复发并梗阻中的应用. 中国介入影像与治疗学, 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. 张连阳, 姚元章, 王韬, 等. 直肠癌术后直肠阴道瘘的治疗策略. 重庆医学, 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. 陈纲, 杜峻峰, 李世拥, 等. 直肠癌术后直肠阴道瘘诊治进展. 临床军医杂志, 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. 张国良, 徐向明, 林建江. 直肠阴道瘘的诊治. 浙江中西医结合杂志, 2013, 23(7): 555-557.
19. 李阿建, 薛利军, 张亚杰, 等. 直肠阴道瘘的临床治疗策略. 外科理论与实践, 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. 荆翌峰, 夏术阶, 孙宏斌, 等. 膀胱肠瘘诊断治疗 12 例报告. 中华泌尿外科杂志, 2006, 27(10): 691-694.
23. 顾晋, 王林. 低位直肠癌术后直肠阴道瘘的诊断和治疗. 中华外科杂志, 2006, 44(23): 1587-1591.

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4 例肠道内瘘患者行转流治疗的临床分析

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