肠瘘治疗进展.ppt

是促进愈合，还是减少肠液量 是加速大坝修复，还是减少上游洪水量 肠外营养 可维持改善营养状态 可减少肠液分泌 生长抑素 减少肠液分泌 肠内营养 促进肠液分泌：增加漏出量？ 促进愈合 Welcome to Nanjing! Research Institute of General Surgery * * 七十年代以后，外科医生对肠损伤与肠外瘘采取阶段性治疗的策略。这策略 * * 七十年代以后，外科医生对肠损伤与肠外瘘采取阶段性治疗的策略。这策略 凝血酶酶切纤维蛋白原,释放出纤维蛋白A肽及B肽,促进纤维蛋白原转化为纤维蛋白,形成纤维蛋白单体,后者可由氢键及静电引力作用聚合成不稳定的可溶性纤维蛋白纤维,凝血因子XIII有催化聚合作用,使纤维蛋白分子交联,聚合成网状,增加凝集强度。 凝血酶同时激活因子XIII,活性态的因子XIIIa在钙离子存在下参与纤维蛋白多肽的交联,使之形成坚固的不易降解的凝块。 纤维蛋白原、凝血因子XIII组成的组分I和凝血酶、纤溶酶抑制剂和氯化钙组成的组分II * 总结前期15例病例 * 胶堵消化道瘘操作过程 ? 盲推：使用双联注射器连接Y型延长管；瘘道镜辅助下的胶堵 * * * 七十年代以后，外科医生对肠损伤与肠外瘘采取阶段性治疗的策略。这策略 Cytokines and other inflammatory mediators induce gaps between endothelial cells by disassembly of intercellular junctions, by altering the cellular cytoskeletal structure, or by directly damaging the cell monolayer. This creation of gaps can result in microvascular leak and tissue edema, which are characteristic of sepsis. A study by London et al. showed that by binding the Robo4 receptor, the Slit protein prevents the dissociation of p120-catenin from VE-cadherin in response to inflammatory mediators, with the result that VE-cadherin remains on the plasma membrane. Thus, the disassembly of intercellular junctions is prevented, and barrier integrity is maintained. A potential therapeutic approach would be to stabilize or enhance Slit-mediated signaling through the Robo4 receptor. Another approach would be to directly stabilize the association between p120-catenin and VE-cadherin. * Even they put many tube drain, they still can not work. * In China, surgeons still used the tube drain for the IAI, and we find it can not work in the IAI with fistula. Sump drain must be used. * As we have no commercial sump drain, we make the sump drain by ourselves. * In the past, we have tried the big bags, * Marlex mesh * And even seen the VAC, but we found they have advantage and disadvantage, for example, in this patients transfered from florida with exposed fistula, maybe a sump drain is good enough for the control of fistula. * Polyp