A systematic review on phased surgical management of in-testinal fistula / 中国现代普通外科进展

ABSTRACT

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.