摘要
复杂肠外瘘病人常经历2次以上腹部手术,且瘘发生后多有严重的腹腔感染,以及重要器官的功能损害。复杂肠外瘘手术常涉及全腹部多个脏器,剥离面大、手术应激反应重、手术时间长,且常对原有手术部位再次手术,更增加了手术的复杂性。因此,肠外瘘手术与一般腹部外科操作既有共性,又有其特殊性与复杂性。复杂肠外瘘的围手术期处理要求明显高于一般腹部外科手术。如果准备不足,轻则出现切口感染、吻合口瘘,重则发生腹腔脓毒症和腹腔大出血危及生命。近年来提出的围手术期外科之家是以循证医学为依据,以病人为中心,贯穿围手术期的所有阶段,综合多学科的系统集成模式。围手术期外科之家的发展是当代外科的进步,其目的包括保障病人生命安全、提高手术质量和促进早期康复,这种理念对于复杂肠外瘘的手术治疗具有一定的借鉴作用。
Patients with complicated enterocutaneous fistulaoften undergo more than two abdominal operations,and afterthe fistula occurs,they often have severe intra-abdominalinfections and damage to the function of important organs.Complicated enterocutaneous fistula surgery often involvesmultiple abdomen organs,with large dissection area,severesurgery stress,and long operation time,and often requiresreoperation of the original surgical site,which increases thecomplexity of the operation.Therefore,the operation ofenterocutaneous fistula and general abdominal surgery havetheir commonalities,but also their particularity andcomplexity.The perioperative treatment requirements forcomplicated enterocutaneous fistulas are significantly higherthan those of general abdominal surgery.A little carelessnessand lack of preparation can cause incision infections andanastomotic leakages.In severe cases,abdominal sepsis andabdominal hemorrhage are life-threatening.In recent years,the perioperative surgical home(PSH)is based on evidence-based medicine,patient-centered,and a comprehensivemultidisciplinary system integration model throughout allstages of the perioperative period.The development of the PSHis the advancement of contemporary surgery.Its goals includeensuring the safety of patients’lives,improving the quality ofsurgery and promoting early rehabilitation.The concept hascertain reference for the surgical treatment of complexparenteral fistula.
作者
黄骞
HUANG Qian(Department of General Surgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第2期133-136,共4页
Chinese Journal of Practical Surgery
基金
国家自然科学基金面上项目(No.82070579)
关键词
肠外瘘
围手术期外科之家
营养支持
腹腔感染
enterocutaneous fistulae
perioperative surgicalhome
nutritional support
intra-abdominal infection
作者简介
黄骞,E-mail:doctorhq@163.com
