摘要术后发生肠瘘,处理不当会导致复杂腹腔感染和脓毒血症,病死率达20%～60%,其治疗费用昂贵,是迄今腹部外科尚未解决的难题之一.在临床上,这类患者常常不能得到早期诊断和处置,在腹腔严重感染情况下,修补破裂肠管的失败率很高,而伴随的腹腔严重粘连、肠壁和肠系膜肿胀,又无法将破裂的肠管拖出造瘘,是外科医生面临的巨大挑战.自1981年Duff和Moffat规范了腹腔开放引流策略治疗严重腹腔感染患者以来,腹腔开放疗法逐渐在临床上开始应用.但在使用的过程中,有学者报道,开放治疗后其病死率并未得到有效控制,甚至有所增加,使得腹腔开放治疗肠瘘并复杂腹腔感染未得到广泛推广.本文回顾了开放引流的历史,复习了开放引流的疗效、时机、指征和开放后的伤口管理的要点,分析了不同中心报道的疗效差异的原因以及腹腔开放治疗肠瘘并复杂腹腔感染的研究进展,为临床医生开放引流治疗肠瘘复杂腹腔感染提供全新视野.

abstractsGastrointestinal fistula patients may suffer from complicated intra-abdominal infection and sepsis with improper treatment, which is characterized by high mortality ranging from 20% to 60%, as well as high medical costs. Gastrointestinal fistula patients with complicated intra-abdominal infections are not often diagnosed early, and proper treatment remains an unsolved problem. Therefore it is a great challenge for surgeons to repair broken intestines under complicated intra-abdominal infection conditions and to repair ruptured intestines under conditions of severe abdominal adhesions and swelling of the intestinal wall and mesentery. After the open abdominal approach was first adopted to treat complicated intra-abdominal infection patients by Duff and Moffat in 1981, it gradually began to be used more widely. However, some investigators have reported that the open abdomen approach has not been effective in controlling controlled mortality, instead, it may even increase mortality. For this reason, the approach has only been used in large medical centers rather than having been widely popularized. In this review, the effect, timing, indications of open abdomen approach and the principles for the open abdominal wound management are summarized, and the reason for the various efficacy among different centers is also analyzed. We provide a new perspective for clinicians to manage the gastrointestinal fistula patients with complicated intra-abdominal infection.