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題 名 | The Effect of TPN on the Outcome of Enterocutaneous Fistula and the Role of Prognosis Nutritional Index Used before Surgery=腸道皮膚瘻管的治療結果及其手術前以營養預後指數作參考的意義 |
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作 者 | 黃燦龍; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 24:3 民80.05-06 |
頁 次 | 頁664-668 |
分類號 | 416.243 |
關鍵詞 | 腸道皮膚瘻管; 治療結果; 營養預後指數; |
語 文 | 英文(English) |
中文摘要 | 對於腸道皮膚瘻管的病人,我們對過去五年來,140位病人的治療結果作分析。所有140位病人均接受高濃度全靜脈營養,其中僅52位病人接受開刀。其中27位病人屬於高流出量的小腸皮膚瘻管,僅一位病人自動癒合,最後的全部死亡率為百分之三十七。另外48位病人屬於低流出量的小腸皮膚瘻管,有百分之五十四點二的病人自動癒合,全部死亡率佔百分之十八點八。至於盲腸皮膚瘻管及大腸皮膚瘻管的兩組病人,各有百分之五十三點三及四十四之自動癒合率,而死亡率則分別為百分之六點七及二十二。對於需要手術治療的病人,高流出量小腸瘻管組的十六位病人中,其術前營養預後指數平均為72,結果有百分之三十七點五的死亡率;屬於低流出量小腸瘻管組的有十三位病人,其術前營養預後指數平均為56,死亡率僅百分之十五點四。至於全部52位需要手術的病人中,其術前營養預後指數高於50者,手術後死亡率佔百分三十七點九;如果指數低於50者,手術後死亡率僅百分之四點三。我們的結論是高濃度全靜脈營養的用,可使得百分之四十點七的腸道皮膚瘻管病人自動癒合,其中以低流出量小腸瘻管或盲腸皮膚瘻管自動癒合的比例較高。術前的營養預後指數如果超過五十,則其手術的危險性高。 |
英文摘要 | 140 patients of enterocutaneous fistula were studied retrospectively. All of them received total parenteral nutrition and only 52 patients underwent surgery afterwards. 27 patients were high output (> 500 ml/day) of small bowel fistula, only one patient (3.7%) resulted in spontaneous closure and the mortality rate was 37%. 48 patients were low output (< 500 ml/ day) of small bowel fistula, of spontaneous closure rate was 54.2% and the mortality rate was 18.8%. The groups of appendical or caecal fistula and colonic fistula had 53.3% and 44.0% of the spontaneous closure rate, 6.7% and 22.0% of the mortality rate individually. For the patients who needed surgery, sixteen patients with high output small bowel fistula, whose preoperative mean prognostic nutritional index (PNI) were 72±18, had 37.5% of the operative mortality. Thirteen patients with low output small bowel fistula, whose preoperative meanPNI were 56±10, had only 15.4% of the operative mortality. The operative mortality was 37.9% ütheir preoperative PNI were higher than 50, while the patients whose PNI were less than 50 had a significantly lower mortality (4.3%). We concluded that total parenteral nutrition resulted in 40.7% of the mean spontaneous closure rate for the whole series of patients with enterocutaneous fistula, the patients with low output of small bowel fistula or appendical/caecal fistula had a higher closure rate. The patients with PNI higher than 50 had high risk for surgery when the conservative treatment failed. |
本系統中英文摘要資訊取自各篇刊載內容。