The Clinic Study Of The Stuff Blocking On The Early Rehabilitation Therapeutics Of The Digestive Tract External Fistula

Objective:We made clinical analysis of the digestive tract fistula in Guangzhou Military Command of PLA in recent 5 year. We combined the " Drainage and determinacy surgery" with "the fast tract surgery", and deployed the stuff blocking on the early time. And We hope to explore a new strategy by the stuff blocking that can foster the patients to the early rehabilitation.Methods:We collected 32 hospitalization cases of the digestive tract fistula in Guangzhou Military Command of PLA from January 2005 to January 2009. GroupThe 32 cases were divided to rehabilitation treatment section and traditional treatment section.Clinical therapeutic method1,The treatment in traditional section is is anti-infection retrieving the disbalance of homeostasis and electrolyte disturbances at the occurrence of the fistula. Then making stuff blocking and determinacy surgery when the body is stabilize 3-6 months later.2,The rehabilitation treatment section closed the fistula orificium early by the fibrin glue,urethral catheter slice and anal orifice sack at the occurrence of the fistula. The patients can have EN and recover at home. Making stuff blocking and determinacy surgery within 1-3 months.Observation indexWe collected the index on infection nutrition immunity before the closure and recorded frequency of hospitalization,frequency of closure,the length of stay and the cost of hospitalization between the two groups. And collect the index on infection nutrition immunity before and after blocking in the rehabilitation treatment section.Statistical methodWe utilized the Excel and SPSS 13.0 software to establish database to analyze the therapeutic efficacy.Results:1,After treatment,10 cases in traditional treatment section were cured (62.5%),4 case ineffective (25%),2 cases dead (12.5%). In traditional treatment section, the four Fistula labiforms were operated 3 months later, 3 ones effective and 1 ineffective for recurrence of fistula.2,In the rehabilitation treatment section,12 cases curative (75%),3 case ineffective (18.75%),1 case dead (6.25%). Three Fistula labiforms in rehabilitation treatment section were put into surgery early, of which the 3 patients develop fistula once again.3,The state of the infection nourishment immunity was improved after EN in the rehabilitation treatment section.4,The part index of inflammation and nutrition had significant deviation, but the immunity had no significant difference in the two sections.5,The time of TPN and EN shortened markedly in the rehabilitation treatment section, and the patient had little time for the determinacy treatment.6,The length of stay and the cost of rehabilitation treatment section were less than those of the traditional treatment section.Conclusion:1,In the rehabilitation treatment section, the patients can have EN early and the state of nutrition,infection and immunity has much improved. That can settle good ground for the determinacy treatment.2,The state of immunity was improved after EN in the rehabilitation treatment section. Maybe it was the important factor for the determinacy treatment.3,It can decrease the time of TPN and EN markedly in the rehabilitation treatment section, and foster the patient to recover early. 4,The early determinacy sugery have higher risk of recurrence of fistula, and we should take caution of it.The new mode of "hospitalization - home - rehabilitation -rehospitalization" not only reduce the length of stay and the cost of hospitalization, but also embody the "fast-tract surgery".And it has potential application value in the clinical treatment.