Bartels H
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, Ismaninger Strasse 22, 81675, München.
Chirurg. 2009 Sep;80(9):780-9. doi: 10.1007/s00104-009-1690-3.
Postoperative complications occur in 10% of patients following major visceral surgery. Of these more than 80% are surgical complications, more than 70% are septic complications and more than 60% are related to anastomotic leakage which accounts for the majority of postoperative deaths. To achieve successful management, early diagnosis is mandatory in cases of deviations from the normal postoperative course. Sufficient external drainage of the leakage and prevention of further contamination across the leakage by gastrointestinal contents are the primary therapeutic goals. The spectrum of therapeutic options is different and depends on the location of the leakage in the gastrointestinal tract. In the surgical treatment of peritonitis, the fundamental requirements for successful management are early detection of persistent abdominal sepsis and of newly developing abdominal complications during the treatment. Furthermore early initiation of effective antibiotic concepts is mandatory.
大脏器手术后10%的患者会出现术后并发症。其中,超过80%为手术并发症,超过70%为感染性并发症,超过60%与吻合口漏有关,吻合口漏是术后死亡的主要原因。为实现成功治疗,术后病程出现异常时必须进行早期诊断。漏口充分的外部引流以及防止胃肠道内容物通过漏口造成进一步污染是主要治疗目标。治疗选择范围不同,取决于胃肠道漏口的位置。在腹膜炎的外科治疗中,成功治疗的基本要求是在治疗期间早期发现持续性腹腔感染和新出现的腹部并发症。此外,必须尽早启动有效的抗生素治疗方案。