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Objective:To summarize the surgical management experience on intestinal fistula(IF)patients with phasedtherapy and staged operation.Methods:Retrospectively analyzing the clin-ical data of 255 IF patientsin Beijing Tsinghua Changgung Hospital from January 2016 to December 2019,including age,gender,primary disease,IF causes,IF locations,IF numbers,IF natures,IF times,IF diagnoses and evaluations,nutritional risks,nutritional support,and infection statuses.Ac-cording to the pathophysiological characteristics of IF patients,IF therapy included three phases:Phase Ⅰ(IF acute onset),Phase Ⅱ(IF stable maintenance),Phase Ⅲ(IF deterministic operation).The IF deterministic operation included one-stage operation and multi-stage operation.The relationship between strategies and effects were analyzed in each treatment stage.Results:All 141 patients in Phase Ⅰ entered into Phase Ⅱ,in which 112 cases received complete treatment,28 cases gave up,and 1 case died.In 112 caseswho received complete treatment,75 cases were cured(83.7％),37 cases remained infected.The 37 cases that remained infected were combined with the 114 cases who were primarily hospitalized at Phase Ⅲ,were classified into 151 cases who received IF deter-ministic operations,in which 134 cases received stage Ⅰ surgery,and 17 cases received multi-stage surgery.138 cases were cured(91.4％).Conclusion:Intestinal fistula patients could exhibit a better cure ratio throughphasestherapy,which include the acute onset phase,stable maintenance phase,and deterministic operation phase.It is important to classify IF patients into the correct phase and conduct the corresponding treatment.The staged operations are also the key to the intestinal fistula-surgical strategy.
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There are some problems such as difficulty of pressure control, inconvenience of use and carry, congested easily and dredged hardly in clinical application of vacuum extractor in common use. For solving the above problems, researchers have designed a new portable and pressure stabilized abdominal drainage system which was composed of integral double spherical aspirator and separated double cannula. The new apparatus has achieved good effects in drainage which is suitable for not only rescuing of abdominal trauma and war wound, but also abdominal surgery that manifested as sucking safe and effective, using easily and convenient, that was verified by testing.
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Objective To investigate the efficacy of double cannula with an early oral diet as nutritional support treatment on non-high output enterocutaneous fistulas. Methods Clinical data from patients with non-high output enterocutaneous fistula, who treated with double cannula with an early oral diet (n = 39) and double cannula with enteral nutrition therapy (n = 43), were retrospectively analyzed. The fistulas status and its closure time were recorded. In order to investigate the effect of oral diet on fistula, the inflammation index and nutritional status indicators before and after therapy were recorded. Results Totally 33 cases of the 39 patients with non-high output fistula were cured after therapy on the average (16.4土7.2) days. The distal non-high output fistula patients had better results(93.1％ closed, 15.8 days)than that of the proximal fistula patients(60.0％, 19.8 days). Laboratory inflammation index(TNF-alpha, IL-6, plasma endotoxin and C-reactive protein) were improved significantly (P＜ 0.05) after therapy. The nutrition status of these patients, such as body weight, hemoglobin, serum total protein, albumin, transferrin, and prealbumin increased at the end of fistula compared to that at the beginning of treatment (P＜ 0.05). Prealbumin and retinol binding protein were significantly higher than that in the control group (P＜0.05). Conclusion With double cannula treatment, early normal eating for enteral nutrition is safe and effective, especially in distal enterocutaneous fistulas. Normal oral diet can achieve the results of fistula closure, reduction of the inflammatory reaction, improvement of the nutrition status, avoiding the infliction of the operation and lowering the cost.
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Objective To observe the clinical effect of applying responsibility holistic nursing to patients treated with double cannula irrigation drainage. Methods Seventy cases with severe acute pancreatitis were selected and divided in-to two groups randomly. The control group received conventional nursing ,and the observation group received responsi-bility holistic nursing. The standing time of drainage tube,drainage effect,length of stay and complications of two groups were recorded. And the nursing satisfaction of patients or family member was evaluated. Results The patients operative time,postoperative irrigation and drainage time and hospital stay were (49.57±5.82) min,(10.10±1.04) d and (29.14±3.52) d, significantly shorter than the control group, the cure rate was 97.44% of observation group, signifi-cantly higher than the control group;in the observation group catheter complication rate was 41.03%, significantly low-er than the control group;observation care patients and their families who were very satisfied and satisfied respectively 53.85%and 92.31%, significantly more than those in the control group. These differences were all statistically signifi-cant (P <0.05). Conclusion Applying double cannula washing drainage to the patients treated with double cannula washing drainage not only can reduce the treatment time and improve the treatment effect , but also can reduce the in-cidence rate of adverse reactions and improve the satisfaction degree of patients. So the nursing mode has great signifi-cance in clinical application.