High Output Enterocutaneous Fistula: A Literature Review and a Case Study

高流量肠外瘘：文獻回顧及病例研究

Yan-Tong Chung ； Lin-Lim Li ； Rebecca A Brody

《Asia Pacific Journal of Clinical Nutrition》 21卷3期 (2012/09) Pp. 464-469

https://doi.org/10.6133/apjcn.2012.21.3.20

摘要

肠外瘘是指肠道和皮肤之间的通道。如果肠外瘘每日排出超过五百毫升便被视为高流量肠外瘘。高流量肠外瘘患者的患病和死亡的机率很高。目前没有以科研证据为基础的肠外瘘医疗指引，而需要更多的研究以评估治疗的有效性。然而，肠外瘘患者的治疗应根据现有的科研证据，详细的临床和营养评估，并密切监测管理来拟定。高流量肠外瘘的治疗是复杂和具有挑战性的。它涉及到营养、医学、皮肤护理和心理治疗。这需由不同专业医疗小组依据个别状况来拟定一个适合病患的营养和临床治疗方案，才能达到最佳的治疗效果。高达七十百分比的肠外瘘患者患有营养不良，而营养不良是预测肠外瘘自发愈合的一个重要因素。本篇回顧所要讨论的营养治疗包括：主要营养素及微量营养素的供給，肠内营养和肠外营养辅助。本文将以一个患有多重肠外瘘病人的个案来说明高流量肠外瘘的管理。

關鍵字

肠瘘 ； 皮肤瘘 ； 肠外营养 ； 肠内营养 ； 肠分泌

並列摘要

An enterocutaneous (EC) fistula is referred to as a channel between the gut and the skin. Effluent of an EC fistula of more than 500 ml per day is considered as high output. Patients with high output EC fistulae have a high morbidity and mortality rate. No evidence-based guidelines are available for this condition and more research is required to evaluate the effectiveness of treatment. Nevertheless, patients with fistulae should be managed based on the available evidence, detailed clinical and nutrition assessment, and close monitoring. Management of high output EC fistula is complex and challenging. It involves nutrition, medical, skin care and psychological treatment, which is best managed by a multidisciplinary team. It requires an individualized nutrition and clinical treatment plan to maximize patient outcomes. Up to 70% of patients with fistulae have malnutrition and it is a significant prognostic factor of spontaneous fistula closure. Nutrition therapies including macronutrient and micronutrient delivery, enteral nutrition and parenteral nutrition are discussed in this review. A case study of a patient with multiple EC fistulae is presented to illustrate the management of high output EC fistulae.

並列關鍵字

intestinal fistula ； cutaneous fistula ； parenteral nutrition ； enteral nutrition ； intestinal secretions