负压造口技术在肠空气瘘和造口皮肤黏膜分离中的应用

doi:10.3877/cma.j.issn.1674-392X.2025.05.006

中华疝和腹壁外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (05) : 518 -522. doi: 10.3877/cma.j.issn.1674-392X.2025.05.006

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负压造口技术在肠空气瘘和造口皮肤黏膜分离中的应用

赵振国¹, 仲卫冬¹, 胡根¹^,^†(

), 刘金春¹, 戴丽强¹, 王镇¹, 浦凌宵¹, 王苏睿², 沈玥帆², 薛徐夏¹^,³, 邵国益¹

¹214400　江苏无锡，南通大学附属江阴医院，江阴市人民医院综合普外一科
²214400　江苏无锡，徐州医科大学江阴临床学院
³226000　江苏南通，南通大学医学院

收稿日期:2025-09-01 出版日期:2025-10-18
通信作者: 胡根
基金资助:
无锡市卫生健康委中青年拔尖人才项目(HB2023102); 江阴市中青年卫生优秀人才项目(JYROYT202301); 徐州医科大学附属医院发展基金重点项目(XYFZ202302); 无锡市卫生健康委科技成果与适宜技术推广项目(T202312)

Application of negative pressure ostomy technology in enteroatmospheric fistula and stoma mucocutaneous separation

Zhenguo Zhao¹, Weidong Zhong¹, Gen Hu¹^,^†(), Jinchun Liu¹, Liqiang Dai¹, Zhen Wang¹, Lingxiao Pu¹, Surui Wang², Yuefan Shen², Xuxia Xue¹^,³, Guoyi Shao¹

¹Department of General Surgery, Jiangyin People's Hospital (Affiliated Jiangyin Hospital of Nantong University), Wuxi 214400, Jiangsu Province, China
²Jiangyin Clinical College of Xuzhou Medical University, Wuxi 214400, Jiangsu Province, China
³Medical School of Nantong University, Nantong 226000, Jiangsu Province, China

Received:2025-09-01 Published:2025-10-18
Corresponding author: Gen Hu

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引用本文：

赵振国, 仲卫冬, 胡根, 刘金春, 戴丽强, 王镇, 浦凌宵, 王苏睿, 沈玥帆, 薛徐夏, 邵国益. 负压造口技术在肠空气瘘和造口皮肤黏膜分离中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(05): 518-522.

Zhenguo Zhao, Weidong Zhong, Gen Hu, Jinchun Liu, Liqiang Dai, Zhen Wang, Lingxiao Pu, Surui Wang, Yuefan Shen, Xuxia Xue, Guoyi Shao. Application of negative pressure ostomy technology in enteroatmospheric fistula and stoma mucocutaneous separation[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(05): 518-522.

目的

探讨负压造口技术管理肠空气瘘和造口皮肤黏膜分离的临床疗效。

方法

采用描述性病例系列研究方法，回顾性分析2022年8月至2024年8月江阴市人民医院综合普外科采用负压造口技术管理的11例肠空气瘘及造口皮肤黏膜分离患者的临床资料。主要观察指标为消化液收集管理状况和创面污染情况，次要观察指标包括创面愈合情况、炎症指标和白蛋白水平。

结果

11例患者中，男6例，女5例；平均年龄（62.3±12.5）岁。其中肠空气瘘3例，造口皮肤黏膜分离8例。均接受了负压造口技术治疗，平均治疗时间（26.1±10.7）d，治疗后创面感染均得到控制，创面肉芽组织新鲜；白细胞、C反应蛋白等炎性指标较治疗前均降低（P<0.05）；无创面出血、无新发消化道瘘、无异物残留等并发症。平均随访（24±6.5）个月，截至2025年8月20日末次随访，无消化道狭窄、瘘复发或脓肿形成。

结论

负压造口技术能够有效管理漏出液，并减少瘘口周围创面污染和感染、促进肉芽组织新生。

关键词: 肠空气瘘, 造口皮肤黏膜分离, 负压造口, 腹腔开放

Objective

To evaluate the clinical efficacy of negative-pressure ostomy techniques in managing enteroatmospheric fistula and stoma mucocutaneous separation.

Methods

A retrospective case series study was conducted on clinical data of 11 patients with enteroatmospheric fistula and stoma mucocutaneous separation treated with negative-pressure ostomy techniques in the Department of General Surgery, Jiangyin people's Hospital from August 2022 to August 2024. Primary outcomes included digestive fluid management and wound contamination, while secondary observation indicators included wound healing status, inflammatory markers, and albumin levels.

Results

The study included 11 patients, 6 males and 5 females, with a mean age of (62.3±12.5) years. Among them, 3 cases had enteroatmospheric fistulas, and 8 cases had stoma mucocutaneous separations. All patients underwent negative-pressure ostomy therapy for a mean duration of (26.1±10.7) days. After the treatment, all wound infections were effectively controlled, with healthy granulation tissue formation. Inflammatory markers (white blood cells, C-reactive protein) significantly decreased compared to those before treatment (P<0.05). No complications such as wound bleeding, new-onset digestive tract fistula, or foreign body retention were observed. The mean follow-up duration was (24±6.5) months. By the last follow-up on August 20, 2025, no cases of digestive tract stenosis, fistula recurrence, or abscess formation were detected.

Conclusion

Negative- pressure ostomy techniques can effectively manage leakage fluid, reduce peristomal wound contamination and infection, and promote granulation tissue regeneration.

Key words: Enteroatmospheric fistula, Stoma mucocutaneous separation, Negative-pressure ostomy, Open abdomen

表1 11例患者负压造口技术治疗前后炎症指标、白蛋白水平变化情况比较

观察指标	治疗前	治疗后	t/Z值	P值
白细胞(×10⁹/L,±s)	11.8±3.0	7.3±1.0	6.513	<0.001
C反应蛋白[mg/L,M(Q₁,Q₃)]	80.0(56.0,107.0)	16.0(11.5,19.0)	-2.934	0.003
白蛋白[g/L,M(Q₁,Q₃)]	28.0(24.5,32.5)	36.0(34.0,39.5)	-2.677	0.007

表1 11例患者负压造口技术治疗前后炎症指标、白蛋白水平变化情况比较

观察指标	治疗前	治疗后	t/Z值	P值
白细胞(×10⁹/L,±s)	11.8±3.0	7.3±1.0	6.513	<0.001
C反应蛋白[mg/L,M(Q₁,Q₃)]	80.0(56.0,107.0)	16.0(11.5,19.0)	-2.934	0.003
白蛋白[g/L,M(Q₁,Q₃)]	28.0(24.5,32.5)	36.0(34.0,39.5)	-2.677	0.007

图1 患者清创后形成肠空气瘘，采用负压造口技术管理创面并植皮注：1A腹部正中切口感染、裂开，肌筋膜感染、坏死；1B造口周围皮肤黏膜分离，造口周围组织感染；1C清创后形成肠皮肤瘘；1D负压造口技术管理创面；1E邮票植皮覆盖创面；1F术后2个月创面。

图2 患者造口皮肤黏膜分离，采用负压造口技术管理创面注：2A造口皮肤黏膜完全分离，分离深度达肌层和腹膜并与腹腔相通；2B聚氨酯海绵覆盖创面，造口从海绵开口出，海绵开放周缘采用造口胶封闭；2C造口底盘贴合；2D负压造口技术管理20 d后，造口周围创面与腹腔隔离并明显缩小。

[1]	吴秀文，刘野，张锦鹏，等. 肠空气瘘伴腹壁毁损外科重建策略[J]. 中国实用外科杂志, 2025, 45(3): 299-304.
[2]	Ong WM, Mohd Rosli R, Arulshankar S, et al. Enteroatmospheric fistula - tips, teats and tricks[J]. ANZ J Surg, 2025, 95(3): 571-572.
[3]	中华医学会外科学分会外科感染与重症医学学组，中国医师协会外科医师分会肠瘘专业委员会. 腹腔开放疗法中国专家共识(2023版)[J]. 中华胃肠外科杂志, 2023, 26(3): 207-214.
[4]	仲卫冬，胡根，邵国益. 腹腔开放合并肠空气瘘的管理[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(5): 462-462.
[5]	Rezende-Neto JB, Ductan C, Jurewitsch B, et al. Management of Enteroatmospheric Fistulas: What you need to know[J]. J Trauma Acute Care Surg, 2025, 99(3): 328-338.
[6]	Gaspar Reis S, Bernardo P, Mendonça N, et al. From an Enteroatmospheric to an Enterocutaneous Fistula Using a Condom[J]. Cureus, 2024, 16(11): e74209.
[7]	阎小雨，任炳魁，黄伟鹏，等. 腹腔开放疗法用于非创伤重症患者临床价值的多中心回顾性研究[J]. 中华消化外科杂志, 2024, 23(11): 1416-1422.
[8]	霍蕊，陈永侠，刘全丽，等. 湿性愈合敷料联合伤口评估三角在肠造口皮肤黏膜分离中的应用效果[J]. 蚌埠医学院学报, 2022, 47(8): 1092-1095, 1101.
[9]	Parini D, Bondurri A, Ferrara F, et al. Multidisciplinary Italian Study group for STOmas(MISSTO). Surgical management of ostomy complications: a MISSTO-WSES mapping review[J]. World J Emerg Surg, 2023, 18(1): 48.
[10]	García-Manzanares ME, Lancharro-Bermúdez M, Fernandez-Lasquetty- Blanc B, et al. Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study[J]. J Adv Nurs, 2023, 79(2): 630-640.
[11]	Ding J, Zhu Y, Ge H, et al. Negative Pressure Wound Therapy for Patients With Complicated Mucocutaneous Separation Following Ileal Conduit Urinary Diversion: A Case Series[J]. J Wound Ostomy Continence Nurs, 2023, 50(5): 420-426.
[12]	Subramaniam MH, Liscum KR, Hirshberg A. The floating stoma: a new technique for controlling exposed fistulae in abdominal trauma[J]. J Trauma, 2002, 53(2): 386-388.
[13]	Suter KJL, Fairweather L, Al-Habbal Y, et al. How to isolate a high output enteroatmospheric fistula in the open abdomen with negative pressure therapy: an institution's step by step guide to the VAC donut[J]. ANZ J Surg, 2023, 93(3): 682-686.
[14]	English CJ, Sodade OE, Austin CL, et al. Management of Enteroatmospheric Fistula(EAF) Using a Fistula-Vacuum Assisted Closure(VAC) in a Complicated Abdominal Trauma Case[J]. Cureus, 2023, 15(4): e37668.
[15]	Rekstad LC, Wasmuth HH, Ystgaard B, et al. Topical negative- pressure therapy for small bowel leakage in a frozen abdomen: a technical report[J]. J Trauma Acute Care Surg, 2013, 75(3): 487-491.
[16]	Wang G, Ren J, Liu S, et al. "Fistula patch": making the treatment of enteroatmospheric fistulae in the open abdomen easier[J]. J Trauma Acute Care Surg, 2013, 74(4): 1175-1177.
[17]	Seternes A, Rekstad LC, Lossius W, et al. A method for treatment of deep and superficial enteroatmospheric fistulas in an open abdomen, ChimneyVAC: Ten years experience[J]. World J Surg, 2024, 48(5): 1066-1074.
[18]	Zhang D, Cen J, Li P, et al. Integrated Treatment by an Ostomy Care Team of a Complicated Mucocutaneous Separation After Radical Cystectomy With Ileal Conduit Urinary Diversion: A Case Report[J]. Wound Manag Prev, 2020, 66(8): 22-25.
[19]	李萍，陈慧，庄君龙．快速康复外科在机器人辅助腹腔镜膀胱切除回肠造口术中的应用 [J/OL]．中华腔镜泌尿外科杂志(电子版), 2024, 18(3): 249-253
[20]	Calero Castro FJ, Padillo Eguía A, Durán Muñoz-Cruzado V, et al. Personalized additive manufacturing of devices for the management of enteroatmospheric fistulas[J]. Bioeng Transl Med, 2023, 8(6): e10583.
[21]	《复杂腹壁疝微共识:巨大切口疝》编审委员会，《中华疝和腹壁外科杂志(电子版)》编辑委员会，全国卫生产业企业管理协会疝和腹壁外科产业及临床研究分会复杂腹壁疝及减重专家组. 复杂腹壁疝微共识:巨大切口疝[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(4): 369-373.
[22]	《复杂腹壁疝微共识:肠瘘及感染相关腹壁疝》编审委员会，《中华疝和腹壁外科杂志(电子版)》编辑委员会，全国卫生产业企业管理协会疝和腹壁外科产业及临床研究分会复杂腹壁疝及减重专家组. 复杂腹壁疝微共识:肠瘘及感染相关腹壁疝[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(3): 247-250.

[1]	仲卫冬, 胡根, 邵国益. 腹腔开放合并肠空气瘘的管理[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 462-462.
[2]	胡根, 仲卫冬, 刘金春, 戴丽强, 浦凌宵, 王苏睿, 王镇, 赵振国, 邵国益. 腔内负压吸引联合创面负压引流在腹腔开放合并肠空气瘘中的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(05): 511-517.
[3]	陈国良, 苏宁, 邵国益, 张剑. 基底膜生物补片内脏保护囊在负压辅助临时关腹治疗期间预防肠空气瘘的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(05): 493-497.
[4]	王苏睿, 胡根, 邵国益. A 型肉毒杆菌毒素在腹腔开放后腹壁缺损修复中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 649-653.
[5]	赵振国, 邵国益. 腹腔开放所致复杂腹壁缺损的确定性修复[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(05): 408-412.

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