Van Goor H
Department of Surgery, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Langenbecks Arch Surg. 2002 Oct;387(5-6):191-200. doi: 10.1007/s00423-002-0309-7. Epub 2002 Sep 4.
To decide "how and when to treat intra-abdominal infection" is one of the most important challenges for surgeons interested in abdominal sepsis. The minimally invasive approach to intra-abdominal infection, both diagnostic and therapeutic, has gained great popularity in recent years: the cause of infection is assessed as soon as possible by means of sophisticated radiography and minimally invasive surgery, patients with intra-abdominal infection are treated with the least surgical injury in order not to aggravate the systemic response ("second hit"), and clinicians rely on clinical scoring combined with new imaging techniques to decide for reintervention. In some patients with severe intra-abdominal infection damage control followed by a few planned relaparotomies seems necessary to provide a solid basis for the patient to start recovering. Paying close attention in these patients to maximal support vital systems and preventing local complications seems crucial for their eventual prognosis.
In this context we discuss important surgical topics such as primary resection and anastomosis in perforated diverticulitis, planned relaparotomy vs. relaparotomy "on demand," intra-abdominal hypertension, and primary and delayed abdominal wall closure techniques after operation for severe intra-abdominal infection.
对于关注腹部脓毒症的外科医生而言，决定“如何以及何时治疗腹腔内感染”是最重要的挑战之一。近年来，腹腔内感染的微创诊断和治疗方法广受欢迎：通过先进的影像学检查和微创手术尽快评估感染原因，对腹腔内感染患者进行手术创伤最小的治疗，以免加重全身反应（“二次打击”），临床医生依靠临床评分结合新的成像技术来决定是否再次干预。对于一些严重腹腔内感染患者，采用损伤控制策略并随后进行几次计划性再次剖腹手术似乎是必要的，以便为患者开始康复提供坚实基础。密切关注这些患者的重要生命系统支持和预防局部并发症对其最终预后似乎至关重要。
在此背景下，我们讨论重要的外科话题，如穿孔性憩室炎的一期切除吻合术、计划性再次剖腹手术与“按需”再次剖腹手术、腹腔内高压以及严重腹腔内感染手术后的一期和延迟腹壁关闭技术。
