目的 探讨原发性主动脉消化道瘘的诊断和治疗。方法 报道1例原发性主动脉消化道瘘的诊治经过,并复习有关文献。结果 本例为67岁男性患者,以“腹部不适伴反复便血7个月”入院。急诊行剖腹探查，结合术中肠镜发现腹主动脉瘤十二指肠瘘。十二指肠第3段瘘口用5-0普理灵修补缝合； 行腹主动脉瘤切除，用16 mm×8 mm分叉涤纶人造血管行腹主动脉-人造血管-左髂总动脉、右髂外动脉吻合。术后静脉使用三代头孢抗生素3周,后改用口服抗生素，无发热，切口一期愈合，顺利出院。结论 原发性主动脉消化道瘘罕见、死亡率高,应注意与主动脉瘤患者的消化道出血鉴别。及时诊断和快速外科治疗是提高存活率的关键。
目的 探讨胆石性肠梗阻的诊断与治疗方案。方法 对我科1990~1999年诊治的11例胆石性肠梗阻的临床表现、治疗结果、术前诊断及手术时机与术式选择进行回顾性分析。结果 11例患者均痊愈出院。其中1例患者发生急性肾功衰竭，2例患者切口感染。3例未做十二指肠瘘口处理的患者有2例在半年后行胆囊切除十二指肠瘘口修补治愈。结论 根据患者全身情况选择不同的手术方式均可取得满意的效果。
目的 探讨十二指肠损伤后预防肠瘘的合理手术方式。方法 对我院2005年3月至2009年10月期间收治的28例十二指肠损伤患者的临床资料进行回顾性分析。结果 28例均行手术治疗，其中1例因多器官功能衰竭于术后第2天死亡，3例十二指肠瘘均经保守治疗后痊愈。27例患者术后随访2～6个月（平均3.5个月），2例发生不全性肠梗阻，1例发生盆腔脓肿，均经非手术治疗后痊愈。结论十二指肠损伤后选择合理的手术方式是预防术后发生十二指肠瘘的关键因素。
目的 探讨小肠瘘的外科综合治疗方法。方法 对我科2003年2月至2007年5月收治的24例小肠瘘患者的临床资料进行回顾性分析。结果 24例患者中包括十二指肠瘘5例，空肠瘘7例，回肠瘘12例。予以营养支持、抗感染、腹腔引流和手术的综合治疗。治愈21例，死亡3例。结论 早期规范的外科综合治疗可明显提高小肠瘘的治愈率。
目的 探讨腹腔镜在胆囊十二指肠瘘(cholecystoduodenal fistula)治疗中的应用价值。方法 我院1992年3月至2005年12月期间共实施27例腹腔镜治疗胆囊十二指肠瘘手术，于腹腔镜下发现内瘘并修补瘘口。结果 27例患者手术均成功，无中转开腹，平均手术时间为(90±30) min，术后平均住院5.2 d，无术后出血、十二指肠瘘等并发症，亦无死亡病例。术后随访6～48个月，无十二指肠狭窄、梗阻发生。结论 腹腔镜治疗胆囊十二指肠瘘安全、可行，创伤小、疼痛轻、恢复快。术中对胆囊周围粘连仔细地分离、检查和熟练的腹腔镜技术是手术成功的关键。
ObjectiveTo explore the leakage management and skin care by improved homemade portable vacuum sealing drainage device used for enterocutaneous fistula, in order to solve such confusing problems as leakage collection and nursing for patients with inconvenient activity. MethodsThe homemade portable vacuum sealing drainage device was made by using hydrophilic fiber of silver ion antimicrobial dressings, leak-proof strings, skin protective film, transparent patches, sputum suction tube, bottle of portable infusion, and negative pressure drainage bottle. Between January 2011 and September 2013, patients with enterocutaneous fistula admitted into our hospital were divided into traditional treatment group and portable vacuum sealing treatment group according to the admission time, and traditional center negative pressure suction treatment and portable negative pressure drainage method were used respectively for the two groups of patients. We verified the effect of the mobile vacuum sealing drainage device through comparing these two groups in terms of wound healing time, redness, burst and impregnation of the skin. ResultsThe wound healing time was significantly shorter for patients in the portable vacuum sealing drainage treatment group (P<0.05), and patients in this group also had a lower occurrence of skin redness, impregnation and burst. ConclusionHomemade portable negative pressure drainage device for enterocutaneous fistula patients can reduce the incidence of skin complications such as redness, impregnation and burst, promote patients' activity, and reduce the patients' pain.
目的探讨因结肠癌侵犯所致十二指肠结肠瘘的诊疗方法。 方法收集笔者所在医院1990年1月至2011年12月22年间收治的7例结肠癌并发十二指肠结肠瘘患者的临床资料，对其手术处理方式及愈后情况进行分析。 结果7例均行手术治疗，其中6例肿瘤切除，术后临床症状及体征消失，存活8～39个月后死亡，平均存活时间15.3个月；另1例未能行肿瘤切除，术后37 d因营养不良及多脏器功能衰竭死亡。 结论十二指肠结肠瘘为结肠癌晚期并发症，手术根治效果差，术后生存时间由原发肿瘤特性决定；合理选择手术方式可以有效缓解患者痛苦，提高其生存质量并延长生存期。
ObjectiveTo summarize the causes, clinical manifestations, diagnosis and treatment methods for the intestinoseminal vesicle fistula. MethodLiteratures about intestinoseminal vesicle fistula at home and abroad were retrieved, the causes, clinical manifestations, diagnosis and treatment methods were analyzed. ResultsThe clinical reports of 19 patients with intestinoseminal vesicle fistula were searched.The intestinoseminal vesicle fistula occurred after the rectal low anterior resection with stomal leak, sigmoid diverticulum, inflammatory bowel disease, prostatectomy or radiotherapy.The main clinical symptoms were pneumaturia, fecaluria, fever, scrotal swelling and pain, orchitis, epididymitis and so on.Imaging methods such as enhanced CT or CT with rectal contrast and so on could confirm the diagnosis.The conservative treatment such as indwelling catheter, antibiotics, parenteral nutrition, and the operation methods such as sinus incision and drainage, mucosa/skeletal muscle flap repairment, urine/stool bypass could cure majority of cases. ConclusionsThe intestinoseminal vesicle fistula is a rare and independent disease.Through the discussion of the intestinoseminal vesicle fistula, it could improve the knowledge, and avoid misdiagnosis and mistreatment of the intestinoseminal vesicle fistula.