关键词: 肠瘘, 肠空气瘘, 腹腔感染, 内镜治疗, 营养治疗

Abstract: Progress in diagnosis and treatment of intestinal fistula             WANG Ge-fei. Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing210002, China
Abstract    Intestinal fistula is an unavoidable complication after gastrointestinal surgery，which may lead to intra-abdominal infection，sepsis，intra-abdominal hypertension，abdominal hemorrhage，abdominal wall necrotizing fasciitis，chronic critical illness and multiple organ dysfunction syndrome.Intra-abdominal infection caused by intestinal fistula is the initiating factor of high mortality risk，resulting in a high mortality rate.It should be based on the early direct and indirect signs of intestinal fistula，combined with abdominal symptoms，vital signs，bacteriological and infection marker detection and CT enterography for timely and accurate diagnosis.Adhere to damage control surgery，adopt a phased treatment strategy，clarify the stage of intestinal fistula and the main problems it faces，and develop a phased treatment methods and objectives.Focus on intra-abdominal infections caused by intestinal fistulas，and step-up approach of source control can be adopted. Endoscopic clipping technology is a safe and efficient treatment to promote the healing of intestinal fistulas.For intestinal fistulas which failure to self-heal，definitive surgery can be performed in the situation of the release of abdominal adhesions，improvement of nutritional status and recovery of organ function.Recurrent intestinal fistulas are a frustrating complication，but their treatment strategy is the same as for initial intestinal fistulas.With continued efforts，recurrent intestinal fistulas may also be cured.Enteroatmospheric fistula is a special type of intestinal fistula，3D printed intestinal fistula stents for endoluminal graft exclusion can control the outflow of intestinal fluid and implement enteral nutrition to create conditions for definitive surgical resection of intestinal fistula，digestive tract reconstruction and abdominal wall defect repair. Early and accurate diagnosis of intestinal fistulas and intra-abdominal infections remains a major challenge, and the development of artificial intelligence may provide solutions. Further research is needed on how to balance the treatment of postoperative intestinal fistula meanwhile gastrointestinal tumors, and how to optimize treatment to reduce postoperative intestinal fistula and recurrence of intestinal fistula in Crohn's disease.

Key words: intestinal fistula, enteroatmospheric fistula, intra-abdominal infection, endoscopic therapy, nutrition therapy