Sovliov S A, Strunina O A
Khirurgiia (Mosk). 2001(11):39-43.
Results of diagnosis and treatment of 71 patients with general pancreatogenic peritonitis (7.3% of all patients with general peritonitis) are analyzed. The main diagnostic methods were ultrasound (100% cases), computed tomography (29.5%), laparoscopy (60%). Based on clinical, instrumental, bacteriologic and morphologic examinations primary and secondary pancreatogenic peritonitis are distinguished. Optimal policy of treatment depended on peritonitis forms. In primary (enzyme peritonitis) minimally invasive methods of treatment were used: laparoscopic drainage of abdominal cavity and bursa omentalis, therapeutic blockades etc. in secondary (bacterial) peritonitis wide laparotomy with sanations of abdominal cavity and minor bursa omentalis were used. Consecutive necrectomies and sequestrectomies were preferred (70.2%). Advantages of hemofiltration over other methods of efferent therapy are demonstrated. The above methods of treatment permitted to decrease postoperative lethality in secondary purulent pancreatogenic peritonitis from 68 to 44%.
分析了71例普通胰腺炎性腹膜炎患者（占所有普通腹膜炎患者的7.3%）的诊断和治疗结果。主要诊断方法为超声检查（100%的病例）、计算机断层扫描（29.5%）、腹腔镜检查（60%）。根据临床、仪器、细菌学和形态学检查结果区分原发性和继发性胰腺炎性腹膜炎。最佳治疗策略取决于腹膜炎的类型。对于原发性（酶性腹膜炎），采用微创治疗方法：腹腔镜腹腔和网膜囊引流、治疗性封闭等；对于继发性（细菌性）腹膜炎，则采用广泛剖腹术并对腹腔和小网膜囊进行清创。连续行坏死组织切除术和死骨切除术是首选（70.2%）。已证明血液滤过相对于其他传出治疗方法的优势。上述治疗方法使继发性化脓性胰腺炎性腹膜炎的术后死亡率从68%降至44%。
