科研之友
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摘要
Management of patients with abdominal secondary aorto-enteric fistulae (SAEF) complicating aortic graft replacement is controversial. We retrospectively analyzed the postoperative and long-term outcomes of all consecutive patients operated on for SAEF between 2002 and 2012. All were managed by in situ replacement with a cryopreserved allograft and treatment of the affected digestive tract. Thirty-two patients (median age 65 years) underwent aortic replacement for. SAEF a median of 5 years after initial aortic surgery The fistulae were located in the duodenum (n = 20); small bowel (n = 6), colon (n = 5) or stomach (n = 1). Treatment of the digestive tract included suture (n = 16), resection with anastomosis (n = 12) covered by a defunctioning stoma (n = 1), and Hartmann's procedure (n = 3). Omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had a feeding jejunostomy. Eight patients (25 %) died post-operatively, 3 with a recurrent aorto-enteric fistula. Fifteen (62.5 %) of the remaining patients developed 27 complications, including 6 patients (19 %) with severe morbidity (Dindo III-IV). The reoperation rate was 21 %. The median hospital stay was 33 days. During follow-up (median 15 months), no further patients had a recurrent aorto-enteric fistula. We conclude that surgery for SAEF is a major procedure associated with high mortality and morbidity Good long-term results can be obtained by excision of the prosthetic graft with cryopreserved allograft replacement, and by management in a tertiary referral center with expertise in both vascular and digestive surgery
- 出版日期2013-5
