The clinical effect of continuous irrigation and drainage of abdominal cavity in treatment of intestinal fistula combined with abdominal infection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Le , YU Wenwen , CAO Tingbao , HE Cui , HAN Xiaopeng , LIU Hongbin ,  LI Hongtao

Department of General Surgery,The 940^th Hospital of The People’s Liberation Army Joint Service Support Force, Lanzhou 730050, P. R. China;

Corresponding author：

LI Hongtao, Email: lihongtao528@163.com

Keywords：

peritoneal continuous flushing and drainage; intestinal fistula; abdominal cavity infection

DOI：

10.7507/1007-9424.201808017

Video：

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Objective To explore the clinical efficacy and application significance of continuous irrigation and drainage for intestinal fistula combined with abdominal infection.Methods Clinical data of 62 patients with intestinafistula combined with abdominal infection admitted by Department of General Surgery of The 940^th Hospital of The People’s Liberation Army Joint Service Support Force from March 2012 to March 2017 were retrospectively analyzed. All patients were treated with continuous abdominal flushing and drainage after emergency surgery. The duration of peritoneal flushing, antibiotic use, blood picture recovery, fistula healing, and total hospitalization were summarized.Results All 62 patients were treated successfully without death or septic shock. Among them, 49 cases of intestinal fistula were treated with continuous abdominal flushing and drainage, and 13 cases of intestinal fistula were treated by continuous flushing and drainage of the abdominal cavity. There were 6 cases of abdominal abscess, 5 cases of incision infection, 5 cases of pleural effusion, and 2 cases of pulmonary infection after surgery. The continuous abdominal cavity washing time was (45±21) d, antibiotic use time was (14±7) d, blood image recovery time was (16±8) d, the healing time of fistula was (47±24) d, total length of hospital stay was (56±27) d.Conclusions For intestinal fistula combined with abdominal cavity infection, peritoneal continuous flushing and drainage is related with curative effect, high cure rate, fewer complications, simple washing equipment, simple technology, lower cost, and convenient nursing, which can create a good condition for the complexity or refractory patients with intestinal fistula, and has a high clinical application significance.

Citation： LI Le, YU Wenwen, CAO Tingbao, HE Cui, HAN Xiaopeng, LIU Hongbin, LI Hongtao. The clinical effect of continuous irrigation and drainage of abdominal cavity in treatment of intestinal fistula combined with abdominal infection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1487-1490. doi: 10.7507/1007-9424.201808017 Copy

1.	李吴寒, 赵允召, 赵日升, 等. 负压辅助临时关腹技术用于腹腔开放合并肠空瘘临床价值研究 (附45例报告). 中国实用外科杂志, 2015, 35(7): 760-762, 786.
2.	王艳萍, 王美芬, 董伯素, 等. 严重腹腔感染患者血液滤过对血浆内毒素和细胞因子的影响. 中华医院感染学杂志, 2016, 26(19): 4407-4409.
3.	陈帆, 朱宏亮, 钱洪军, 等. 暂时性腹腔关闭与常规关腹技术治疗严重腹腔感染的临床对比. 中国微创外科杂志, 2015, 15(7): 628-631.
4.	宋平. CT 和 MRI 对脊柱外伤诊断价值的对比研究. 齐齐哈尔医学院学报, 2013, 34(10): 1460-1461.
5.	朱维铭. 腹腔开放与暂时性腹腔关闭规范化实施中的问题与策略. 中国实用外科杂志, 2014, 34(1): 59-62.
6.	伊敏, 白宇, 朱曦, 等. 腹腔内高压对危重患者器官功能的影响. 中国微创外科杂志, 2013, 13(12): 1120-1123.
7.	Ay N, Dinç B, Alp V, et al. Comparison of outcomes of laparoscopic intracorporeal knotting technique in patients with complicated and noncomplicated acute appendicitis. Ther Clin Risk Manag, 2015, 11: 1213-1216.
8.	Wu CC, Huang CF, Shen LJ, et al. Successful elimination of methotrexate by continuous veno-venous haemofiltration in a psoriatic patient with methotrexat psoriatic patient with methotrexate intoxication. Acta Derm Venereol, 2015, 95(5): 626-627.
9.	Mahmood S, Chowhdury SB, Shamim S, et al. A comparative study of abdominal hysterectomy versus vaginal hysterectomy in non descent cases. Mymensingh Med J, 2015, 24(3): 521-527.
10.	Kozioł M, Targońska S, Stążka J, et al. Gentamicin-impregnated collagen sponge for preventing sternal wound infection after cardiac surgery. Kardiochir Torakochirurgia Pol, 2014, 11(1): 21-25.
11.	Liu K, Meng J, Yang S, et al. Transcatheter thrombolysis combined with damage control surgery for treatment of acute mesenteric venous thrombosis associated with bowel necrosis: a retrospective study. World J Emerg Surg, 2015, 10: 50.
12.	Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goal-directed therapy. PLoS One, 2015, 10(7): e0132109.
13.	林超, 吴文川, 戎叶飞, 等. 普外科死亡病人血清降钙素原峰值变化趋势研究 (附 28 例报告). 中国实用外科杂志, 2015, 35(11): 1229-1231.
14.	陈园园, 张蓉, 朱丽, 等. 新生儿胃肠穿孔 80 例临床特点及预后分析. 中国实用儿科杂志, 2017, 32(2): 141-144, 148.
15.	Shang Y, Mu L, Guo X, et al. Clinical significance of interleukin-6, tumor necrosis factor-α and high-sensitivity C-reactive protein in neonates with hypoxic-ischemic encephalopathy. Exp Ther Med, 2014, 8(4): 1259-1262.
16.	Jamal JA, Roberts DM, Udy AA, et al. Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration. Int J Antimicrob Agents, 2015, 46(1): 39-44.
17.	梁永生, 张春艳, 李敬伟, 等. 血必净注射液治疗老年严重腹腔感染疗效观察. 现代中西医结合杂志, 2017, 26(19): 2156-2158.
18.	钟静霞, 姬舒荣, 王铭河, 等. 胃肠术后早期肠内营养对患者预后影响的 Meta 分析. 中华胃肠外科杂志, 2013, 16(11): 1035-1040.
19.	Zou L, Ke L, Li W, et al. Enteral nutrition within 72 h after onset of acute pancreatitis vs delayed initiation. Eur J Clin Nutr, 2014, 68(12): 1288-1293.
20.	胡杰, 姚元团, 代大华, 等. 早期肠内营养对消化道穿孔腹腔感染术后病人炎性指标和蛋白质水平的影响. 肠外与肠内营养, 2015, 22(5): 257-260.
21.	Klein JD, Turner CG, Kamran SC, et al. Pediatric postoperative intussusception in the minimally invasive surgery era: a 13-year, single center experience. J Am Coll Surg, 2013, 216(6): 1089-1093.
22.	Roger C, Muller L, Wallis SC, et al. Population pharmacokinetics of linezolid in critically ill patients on renal replacement therapy: comparison of equal doses in continuous venovenous haemofiltration and continuous venovenous haemodiafiltration. J Antimicrob Chemother, 2016, 71(2): 464-470.
23.	Levin DE, Pegoli W Jr. Abscess after appendectomy: predisposing factors. Adv Surg, 2015, 49: 263-280.

1. 李吴寒, 赵允召, 赵日升, 等. 负压辅助临时关腹技术用于腹腔开放合并肠空瘘临床价值研究 (附45例报告). 中国实用外科杂志, 2015, 35(7): 760-762, 786.
2. 王艳萍, 王美芬, 董伯素, 等. 严重腹腔感染患者血液滤过对血浆内毒素和细胞因子的影响. 中华医院感染学杂志, 2016, 26(19): 4407-4409.
3. 陈帆, 朱宏亮, 钱洪军, 等. 暂时性腹腔关闭与常规关腹技术治疗严重腹腔感染的临床对比. 中国微创外科杂志, 2015, 15(7): 628-631.
4. 宋平. CT 和 MRI 对脊柱外伤诊断价值的对比研究. 齐齐哈尔医学院学报, 2013, 34(10): 1460-1461.
5. 朱维铭. 腹腔开放与暂时性腹腔关闭规范化实施中的问题与策略. 中国实用外科杂志, 2014, 34(1): 59-62.
6. 伊敏, 白宇, 朱曦, 等. 腹腔内高压对危重患者器官功能的影响. 中国微创外科杂志, 2013, 13(12): 1120-1123.
7. Ay N, Dinç B, Alp V, et al. Comparison of outcomes of laparoscopic intracorporeal knotting technique in patients with complicated and noncomplicated acute appendicitis. Ther Clin Risk Manag, 2015, 11: 1213-1216.
8. Wu CC, Huang CF, Shen LJ, et al. Successful elimination of methotrexate by continuous veno-venous haemofiltration in a psoriatic patient with methotrexat psoriatic patient with methotrexate intoxication. Acta Derm Venereol, 2015, 95(5): 626-627.
9. Mahmood S, Chowhdury SB, Shamim S, et al. A comparative study of abdominal hysterectomy versus vaginal hysterectomy in non descent cases. Mymensingh Med J, 2015, 24(3): 521-527.
10. Kozioł M, Targońska S, Stążka J, et al. Gentamicin-impregnated collagen sponge for preventing sternal wound infection after cardiac surgery. Kardiochir Torakochirurgia Pol, 2014, 11(1): 21-25.
11. Liu K, Meng J, Yang S, et al. Transcatheter thrombolysis combined with damage control surgery for treatment of acute mesenteric venous thrombosis associated with bowel necrosis: a retrospective study. World J Emerg Surg, 2015, 10: 50.
12. Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goal-directed therapy. PLoS One, 2015, 10(7): e0132109.
13. 林超, 吴文川, 戎叶飞, 等. 普外科死亡病人血清降钙素原峰值变化趋势研究 (附 28 例报告). 中国实用外科杂志, 2015, 35(11): 1229-1231.
14. 陈园园, 张蓉, 朱丽, 等. 新生儿胃肠穿孔 80 例临床特点及预后分析. 中国实用儿科杂志, 2017, 32(2): 141-144, 148.
15. Shang Y, Mu L, Guo X, et al. Clinical significance of interleukin-6, tumor necrosis factor-α and high-sensitivity C-reactive protein in neonates with hypoxic-ischemic encephalopathy. Exp Ther Med, 2014, 8(4): 1259-1262.
16. Jamal JA, Roberts DM, Udy AA, et al. Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration. Int J Antimicrob Agents, 2015, 46(1): 39-44.
17. 梁永生, 张春艳, 李敬伟, 等. 血必净注射液治疗老年严重腹腔感染疗效观察. 现代中西医结合杂志, 2017, 26(19): 2156-2158.
18. 钟静霞, 姬舒荣, 王铭河, 等. 胃肠术后早期肠内营养对患者预后影响的 Meta 分析. 中华胃肠外科杂志, 2013, 16(11): 1035-1040.
19. Zou L, Ke L, Li W, et al. Enteral nutrition within 72 h after onset of acute pancreatitis vs delayed initiation. Eur J Clin Nutr, 2014, 68(12): 1288-1293.
20. 胡杰, 姚元团, 代大华, 等. 早期肠内营养对消化道穿孔腹腔感染术后病人炎性指标和蛋白质水平的影响. 肠外与肠内营养, 2015, 22(5): 257-260.
21. Klein JD, Turner CG, Kamran SC, et al. Pediatric postoperative intussusception in the minimally invasive surgery era: a 13-year, single center experience. J Am Coll Surg, 2013, 216(6): 1089-1093.
22. Roger C, Muller L, Wallis SC, et al. Population pharmacokinetics of linezolid in critically ill patients on renal replacement therapy: comparison of equal doses in continuous venovenous haemofiltration and continuous venovenous haemodiafiltration. J Antimicrob Chemother, 2016, 71(2): 464-470.
23. Levin DE, Pegoli W Jr. Abscess after appendectomy: predisposing factors. Adv Surg, 2015, 49: 263-280.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The clinical effect of continuous irrigation and drainage of abdominal cavity in treatment of intestinal fistula combined with abdominal infection

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