Mulier Stefaan, Penninckx Freddy, Verwaest Charles, Filez Ludo, Aerts Raymond, Fieuws Steffen, Lauwers Peter
Department of Abdominal Surgery, University Clinic Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium.
World J Surg. 2003 Apr;27(4):379-84. doi: 10.1007/s00268-002-6705-x.
Mortality of generalized postoperative peritonitis remains high at 22% to 55%. The aim of the present study was to identify prognostic factors by means of univariate and multivariate analysis in a consecutive series of 96 patients. Mortality was 30%. Inability to clear the abdominal infection or to control the septic source, older age, and unconsciousness were significant factors related to mortality in the multivariate analysis. Failure to control the peritoneal infection (15%) was always fatal and correlated with failed septic source control, high Acute Physiology and Chronic Health Evaluation (APACHE) II score, and male gender. Failure to control the septic source (8%) also was always fatal and correlated with high APACHE II score and therapeutic delay. In patients with immediate source control, residual peritonitis occurred in 9% after purulent or biliary peritonitis and in 41% after fecal peritonitis ( p = 0.002). In patients without immediate control of the septic source, delayed control was still achieved in 100% after a planned relaparotomy (PR) strategy versus 43% after an on-demand relaparotomy (ODR) strategy ( p = 0.018). In the same patients, mortality was 0% in the PR group versus 64% in the ODR group ( p = 0.007). Early relaparotomy is related to improved septic source control. After relaparotomy for generalized postoperative peritonitis, a PR strategy is indicated whenever source control is uncertain. It also might decrease mortality in fecal peritonitis. An ODR approach is adequate for purulent and biliary peritonitis with safe septic source control.
广泛性术后腹膜炎的死亡率仍居高不下，为22%至55%。本研究的目的是通过单因素和多因素分析，对连续的96例患者进行预后因素的识别。死亡率为30%。多因素分析显示，无法清除腹腔感染或控制感染源、年龄较大以及意识不清是与死亡率相关的重要因素。未能控制腹膜感染（15%）总是致命的，且与感染源控制失败、急性生理与慢性健康状况评分系统（APACHE）II高分以及男性性别相关。未能控制感染源（8%）也总是致命的，且与APACHE II高分和治疗延迟相关。在感染源立即得到控制的患者中，脓性或胆汁性腹膜炎后残留腹膜炎的发生率为9%，粪性腹膜炎后为41%（p = 0.002）。在感染源未立即得到控制的患者中，计划性再次剖腹探查（PR）策略后延迟控制的成功率为100%，而按需再次剖腹探查（ODR）策略后为43%（p = 0.018）。在这些患者中，PR组的死亡率为0%，而ODR组为64%（p = 0.007）。早期再次剖腹探查与改善感染源控制相关。对于广泛性术后腹膜炎进行再次剖腹探查后，只要感染源控制情况不确定，就应采用PR策略。这也可能降低粪性腹膜炎的死亡率。对于脓性和胆汁性腹膜炎且感染源控制安全的情况，ODR方法是合适的。
