Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Eur J Med Res. 2009 Nov 3;14(11):491-6. doi: 10.1186/2047-783x-14-11-491.
Current criteria for performing relaparotomy for suspected peritonitis are non explicit and based on non-quantitative, subjective arguments or hospital practice. The aim of this study was to determine the value of routinely used clinical and diagnostic parameters in early detection of postoperative, diffuse peritonitis (PP). Furthermore, the prognosis and outcome after early indication for relaparotomy in patients with PP compared to community-aquired peritonitis (CAP) was evaluated.
Between 1999 and 2008, a total of 251 patients with diffuse secondary peritonitis either postoperative (PP) or community acquired (CAP) were analyzed retrospectively. PP (n = 114) and CAP (n = 137) were compared regarding physical examination, MPI-Score, APACHE II-Score, evidence of organ failure, laboratory parameters, diagnostic instruments and clinical course. The treatment regimen comprised surgical source control (with/without programmed lavage), abdominal closure and relaparotomy on demand, broad spectrum antibiotic therapy and intensive care support.
The APACHE II-Score (20 CAP vs. 22 PP, p = 0.012), MPI-Score (27 CAP vs. 30 PP, p = 0.001) and the number of lavages differed significantly. Positive phyiscal testing and signs of sepsis (abdominal pain (81.6% PP vs. CAP 97.1%, p = 0.03), rebound tenderness (21.9% vs. 35.8%, p = 0.02), fever (35.1% vs. 51.8%, p = 0.03)) occurred significantly less often in the PP patients than in the CAP group. Conventional radiography (66.2%) and ultrasonography (44.3%) had a lower diagnostic sensitivity than did abdominal CT-scan (97.2%). Mortality was higher in the PP group but did not differ significantly between the two groups (47.4% PP vs. 35.8% CAP, p = 0.06).
The value of physical tests and laboratory parameters in diagnosing abdominal sepsis is limited. CT-scanning revealed the highest diagnostic accuracy. A treatment regimen of early relaprotomy appears to be the most reasonable strategy for as early discovery of postoperative peritonitis as possible.
目前，对于疑似腹膜炎进行剖腹探查的标准并不明确，主要基于非定量的、主观的观点或医院惯例。本研究旨在确定常规使用的临床和诊断参数在早期发现术后弥漫性腹膜炎（PP）中的价值。此外，还评估了与社区获得性腹膜炎（CAP）相比，在出现弥漫性腹膜炎（PP）时早期剖腹探查的预后和结局。
1999 年至 2008 年间，回顾性分析了 251 例弥漫性继发性腹膜炎患者，分为术后（PP）和社区获得性（CAP）。对 PP（n=114）和 CAP（n=137）两组患者进行体格检查、MPI 评分、APACHE II 评分、器官衰竭证据、实验室参数、诊断仪器和临床过程的比较。治疗方案包括手术源控制（有/无计划冲洗）、腹部闭合和按需剖腹探查、广谱抗生素治疗和重症监护支持。
APACHE II 评分（20 例 CAP 与 22 例 PP，p=0.012）、MPI 评分（27 例 CAP 与 30 例 PP，p=0.001）和冲洗次数有显著差异。阳性物理检查和败血症迹象（腹痛（81.6%PP 与 CAP 97.1%，p=0.03）、反跳痛（21.9%与 35.8%，p=0.02）、发热（35.1%与 51.8%，p=0.03））在 PP 患者中发生率显著低于 CAP 组。常规放射摄影（66.2%）和超声（44.3%）的诊断敏感性低于腹部 CT 扫描（97.2%）。PP 组死亡率较高，但两组之间无显著差异（47.4%PP 与 35.8%CAP，p=0.06）。
物理检查和实验室参数在诊断腹部感染的价值有限。CT 扫描显示出最高的诊断准确性。早期剖腹探查的治疗方案似乎是早期发现术后腹膜炎的最合理策略。
