A Feasibility Study On Pathophysiological Classification Of Enterocutaneous Fistula

Objective: To do a study on feasibility of pathophysiological classification ofenterocutaneous fistula（ECF）, to provide a theoretical basis for reasonably selecting thetreatment strategy of ECF. Methods: Retrospective study was performed according toclinic data of188cases of eligible ECFs who were received hospitalization in ourgastrointestinal surgery department during the periods from2000to2012. The relationshipbetween the primary pathophysiological changes(infection, bleeding or/and malnutrition)which could seriously threaten lives of patients in the development of ECF and the localityof fistula was analyzed through statistics. The ECFs were typed subjectively by the localityof fistula: located above the gastric antrum was defined as fistula type I; located in thegastric antrum,duodenum, high jejunum(less than100cm from the Treitz ligament) wasdefined as fistula type II; located down far from the high jejunum(including low jejunumfistula appendix fistula colonic fistula and rectal fistula) was defined as fistula type III.Results：During the course of different types of ECFs, the pathophysiological changeswhich could seriously threaten lives of patients, for23cases of fistula type I, infectionaccounted for13.04%, bleeding accounted for0, malnutrition accounted for86.96%; for56cases of fistula type II, infection accounted for86.96%, bleeding accounted for42.86%,malnutrition accounted for78.57%; for109cases of fistula type III, infection accounted for88.07%, bleeding accounted for0, malnutrition accounted for11.93%. Chi-square teststatistic analyses were done by SPSS19.0software. Among three types cases whosepathophysiological change that could seriously threaten patients’ lives was infection, therewas no statistical difference between fistula type I and type II（P=0.584）; There was statistically significant difference between fistula type I and type III, also between fistulatype II and type III (P<0.001). Among three types cases whose pathophysiological changethat could seriously threaten patients’ lives was bleeding, there was no statistical differencebetween fistula type I and type III（P=1）; There was statistically significant differencebetween fistula type I and type II, also between fistula type II and type III (P<0.001).Among three types cases whose pathophysiological change that could seriously threatenpatients’ lives was infection, there was no statistical difference between fistula type I andtype II（P=0.584）; There was statistically significant difference between fistula type I andtype III, also between fistula type II and type III (P<0.001).Conclusion: There weresignificant classification classification differences between the pathophysiological changeswhich could seriously threaten lives of patients during the course of ECF and the locality offistula. ECF of type I, was mainly malnutrition; ECF of type II, was mainly bleeding; ECFof type III, was mainly infection. Therefore，ECFs classified by pathophysiological changeswas entirely feasible. Focuses of prevention and cure for different types of ECFs was alsorelatively different.