Comparative Study Of First Choice Surgical Treatment And Non-operative Treatment For Iatrogenic Duodenal Fistula

Objective:Comparison of the feasibility and superiority of non-surgical treatment for iatrogenic external duodenal fistulaMethod:1.From December 2014 to December 2017,42 patients(29 males and 13 females)with duodenal fistula treated in our hospital were retrospectively analyzed,including 24 cases of non-operative treatment and 18 cases of surgical treatment.2.The duration of hospitalization,the cost of hospitalization,the number of times of operation in ICU,the duration of ventilator,the time of use of carbapenem antibiotics,the time required for the recovery of albumin and white blood cells and the complications were compared between the operation group and the operation group.Outcome of discharge,digestive tract reconstruction and shock.3.The statistical analysis was performed with SPSS21.0 software,t test and ?2 squared analysis,comparing the two is statistically significant.Result:The hospitalization time of the operation group was significantly higher than that of the non-operative group,and the difference between the two groups was statistically significant(t=2.37,3.11 P<0.05).The times of operation in the two groups were(3.67±0.97)times and(1.61±0.46)times respectively,and there were significant differences between the two groups.The difference was statistically significant(t=6.565,P<0.05).Compared with the non-operative group,the hospitalization time of ICU,the time of ventilator use and the use time of carbapenomycin antibiotics in the operation group were significantly longer than those in the non-operative group[(14.61±16.30)VS(4.83±8.09)(6.89±7.403)VS(2.29±4.85),(2.1±14.511)VS(9.67±9.69)].There was significant difference between the two groups(t=2.337,2.287,2.896 P<0.05);and the time needed for the recovery of prealbumin and white blood cells in the operation group was(43.22±24.18,33.51±24.35)days,which was significantly longer than that in the non-operative group(22.83± 12.49,13.88±8.97)days,And there is statistical significance(P<0.05).At the same time,(72.2%and 55.6%)in the operation group were significantly higher than that in the non-operative group(41.7%and 16.7%).The difference between the two groups was statistically significant(?2=3.87,7.20,P<0.05).The incidence of intraperitoneal infection,sepsis,fungal infection,hemorrhage and multiple fistula in the operation group were 88.9%?66.7%?27.80%?47.1%and 33.3%,respectively,compared with those in the non-operative group(58.3%?33.2%?29.21%?52.9%and 8.3%,),The incidence of intraperitoneal infection,sepsis and multiple fistula was significantly higher in the operative group than in the non-operative group,and the difference was statistically significant(?2=4.70,4.58 ?4.1 P<0.05);However,the fungal infection and bleeding were similar,but there was no significant difference between them(?2=0.01 ? 0.20 P>0.05).The mortality of the operative group was significantly higher than that of the conservative group,but there was no significant difference in the overall discharge outcome(?2=0.7 P>0.05).Conclusion:The treatment of iatrogenic outside duodenal fistula regardless of the preferred surgical or non-surgical treatment,should be to outside the cavity cavity open drainage,restoring enteral nutrition as the therapeutic principles;For most patients with iatrogenic outside duodenal fistula,preferred non-surgical treatment of traumatic light,easy to implement,shorter hospitalization time,spend less,etc.