~Teachingcenter的醫學筆記~

腸皮廔管Enterocutaneous Fistula

腸皮廔管出現時，一般不需要太早就手術處理，可以觀察3~4個月
不過若有以下的情形，就可以考慮早些手術治療(HIS FRIEND)：
High-output (流量大於500mL/day，則難自行癒合)
Infection (感染的廔管不會自行癒合)
Short distance to skin (腸道開口距離皮膚小於2cm難癒合)
Foreign body (有異物則不會癒合，如引流管)
Radiation (廔管處曾接受過放射治療則難癒合)
Inflammation (IBS等發炎的腸道難癒合)
Epithelialization of the fistula tract or Eversion of mucosa (上皮生成或黏膜外翻)
Neoplasm (癌症難癒合)
Distal obstruction (在廔管的下游有阻塞)

可以自行癒合的因子
Favorable predictive factors for spontaneous closure of enterocutaneous fistula
1. 位置Organ of origin (不同位置有不同的分泌量和壓力)
= Esophageal better than Gastric
= Duodenal stump better than Lateral duodenal
= Jejunum better than Ilium
2. 成因Etiology
= 相對較好：Postoperative (anastomotic leakage), Appendicitis, Diverticulitis
= 相對不好：Malignancy, Inflammatory bowel disease
3. 流出量Output
= 少量Low <200 mL/day →好，自行癒合率高
= 兩者之間，可以觀察3~4個月後決定
= 量多High >500 mL/day →差，建議手術治療
4. 營養狀況Nutritional status
= Well nourished better than Malnourished
= Transferrin > 200mg/dL bettern than < 200 mg/dL
5. 沒有敗血的情形Absence of Sepsis
6. 腸道的狀態State of bowel
= 連續無阻塞，癒合率高(Intestinal continuity, Absence of obstruction)
= 不曾接受或放療(No previous irradiation)
7. 廔管的狀態Fistula characteristcs
= 廔管長，Tract > 2cm，較容易癒合
= 開口小，Defect < 1 cm，較容易癒合