Chernov V N, Belik B M
Khirurgiia (Mosk). 2002(4):52-6.
State of immune-secretory system of intestinal mucosa, bacterial contamination of the small intestine, peritoneal exudate, portal and systemic venous blood, ultrastructural changes in the liver (electron microscopy) were studied in 167 patients with general acute purulent peritonitis (APP) and clinical-laboratory symptoms of endotoxicosis. It is demonstrated that the main links of APP pathogenesis are disorders of small intestine barrier function, massive bacterial translocation from intestinal lumen to abdominal cavity and portal circulation, damage of reticuloendothelial hepatic barrier manifested as fulminant macrophagal hepatic failure, "bursting" of infectious-toxic agents into systemic circulation with resultant toxico-septic shock and visceral insufficiency. This approach permits to classify three clinical stages of APP and to propose differential surgical policy and detoxication treatment for these patients.
对167例伴有内毒素血症临床实验室症状的急性化脓性腹膜炎（APP）患者，研究了其肠黏膜免疫分泌系统状态、小肠细菌污染情况、腹腔渗出液、门静脉和体静脉血，以及肝脏的超微结构变化（电子显微镜检查）。结果表明，APP发病机制的主要环节是小肠屏障功能紊乱、大量细菌从肠腔转移至腹腔和门静脉循环、网状内皮肝屏障受损表现为暴发性巨噬细胞性肝衰竭、感染性毒素进入体循环导致中毒性休克和内脏功能不全。这种方法有助于对APP的三个临床阶段进行分类，并为这些患者提出差异化的手术策略和解毒治疗方案。
