Objective: To investigate the
diagnosis and
treatment for intra-abdominal
fistula in
China , and to explore the
prognostic factors .
Methods: A multi-center
cross-sectional study was conducted based on the Registration System of
Chinese Gastrointestinal
Fistula and
Intra-Abdominal Infections to collect the clinical data of
patients with intra-abdominal
fistula from 18 medical centers from January 1, 2018 to December 31, 2018, including basic information,
medical records and
prognosis .
Results: A total of 106
patients were enrolled in this study, including 57
males and 49
females , with an average age of (48.0±17.8)years. The most common type of intra-abdominal
fistula was entero-
vesical fistula (34.0%), followed by entero-
vaginal fistula (31.1%), entero-enteric
fistula (26.4%) and multiple
fistula (8.5%). The direct causes of intra-abdominal
fistula were mainly surgical operation (66.0%), followed by spontaneous
fistula due to Crohn′s
disease (18.9%),
radiation intestinal
injury (11.3%), and 4 cases (3.8%) of unknown reasons. During the whole
treatment , 95
patients received
nutritional support therapy , mainly EN+ PN (75.8%). Finally, 86
patients (81.1%) received surgical
treatment , with a healing rate of 95.3%. After
surgery , 8.1% of
patients developed
surgical site infections (SSI), and 10.5% had a
relapse of
fistula . 20
patients (18.9%) were treated conservatively, with a
self -healing rate of 80.0%. The overall mortality rate was 8.5%, and the highest
mortality (15.2%) was found in entero-enteric
fistula .
Statistical analysis showed that the age ( t=-4.664, P<0.001), leucocyte level ( U=663.000, P=0.010),
sepsis ( P=0.002) and
multiple organ dysfunction syndrome (
MODS ) ( P=0.019) were higher in the
death group than those in the healing group.
Multivariate analysis suggested that advanced age ( OR=1.073, 95% CI 1.008-1.141, P=0.026) and
complications of
sepsis ( OR=11.806, 95% CI 1.064-131.048, P=0.044) were independent
risk factors of the
death for
patients with intra-abdominal
fistula .
Conclusions: The overall mortality rate of intra-abdominal
fistula is still high, and malignant
tumor is the most common primary
disease . Advanced age and
sepsis are independent
risk factors for
death in
patients with intra-abdominal
fistula .