Abstract: Examination the surgical treatment of complex parenteral fistula from the perspective of the perioperative surgical home        HUANG Qian. Department of General Surgery, General Hospital of Eastern Theater Command, PLA, Nanjing 210002,China
Abstract    Patients with complicated enterocutaneous fistula often undergo more than two abdominal operations, and after the fistula occurs, they often have severe intra-abdominal infections and damage to the function of important organs. Complicated enterocutaneous fistula surgery often involves multiple abdomen organs, with large dissection area, severe surgery stress, and long operation time, and often requires reoperation of the original surgical site, which increases the complexity of the operation. Therefore, the operation of enterocutaneous fistula and general abdominal surgery have their commonalities, but also their particularity and complexity. The perioperative treatment requirements for complicated enterocutaneous fistulas are significantly higher than those of general abdominal surgery. A little carelessness and lack of preparation can cause incision infections and anastomotic leakages. In severe cases, abdominal sepsis and abdominal hemorrhage are life-threatening. In recent years, the perioperative surgical home (PSH) is based on evidence-based medicine, patient-centered, and a comprehensive multidisciplinary system integration model throughout all stages of the perioperative period. The development of the PSH is the advancement of contemporary surgery. Its goals include ensuring the safety of patients' lives, improving the quality of surgery and promoting early rehabilitation. The concept has certain reference for the surgical treatment of complex parenteral fistula.

Key words: enterocutaneous fistulae, perioperative surgical home, nutritional support, intra-abdominal infection

摘要： 复杂肠外瘘病人常经历2次以上腹部手术，且瘘发生后多有严重的腹腔感染，以及重要器官的功能损害。复杂肠外瘘手术常涉及全腹部多个脏器，剥离面大、手术应激反应重、手术时间长，且常对原有手术部位再次手术，更增加了手术的复杂性。因此，肠外瘘手术与一般腹部外科操作既有共性，又有其特殊性与复杂性。复杂肠外瘘的围手术期处理要求明显高于一般腹部外科手术。如果准备不足，轻则出现切口感染、吻合口瘘，重则发生腹腔脓毒症和腹腔大出血危及生命。近年来提出的围手术期外科之家是以循证医学为依据，以病人为中心，贯穿围手术期的所有阶段，综合多学科的系统集成模式。围手术期外科之家的发展是当代外科的进步，其目的包括保障病人生命安全、提高手术质量和促进早期康复，这种理念对于复杂肠外瘘的手术治疗具有一定的借鉴作用。

关键词: 肠外瘘, 围手术期外科之家, 营养支持, 腹腔感染